Nakashima O, Kojiro M
Department of Pathology, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0067, Japan.
J Hepatobiliary Pancreat Surg. 2001;8(5):404-9. doi: 10.1007/s005340100001.
Recurrence after successful surgical or nonsurgical treatment of hepatocellular carcinoma (HCC) is caused either by intrahepatic metastasis or by metachronously multicentric occurrence. Intrahepatic metastasis is a major cause of recurrence of advanced HCCs with varying degrees of vascular invasion, and multicentric occurrence is a frequent cause of recurrence in small HCCs with no obvious vascular invasion. It is estimated that at least 20% of small HCCs have a high probability of recurrence due to multicentric occurrence, based on the finding that adenomatous hyperplasia (AH) and/or atypical adenomatous hyperplasia (AAH), which are considered premalignant lesions, are found in the vicinity of resected small HCCs with liver cirrhosis. However, because neither AH nor AAH occur in HCC cases without liver cirrhosis, most recurrence of HCC in noncirrhotic liver is considered to be due to intrahepatic metastasis or to de novo hepatocarcinogenesis. In a survey of autopsy cases of liver cirrhosis with small HCC, smaller HCC nodules were found in other liver slices in 50% of cases, and it is estimated that approximately 50% of HCC is already multicentric in the early stage.
肝细胞癌（HCC）经手术或非手术成功治疗后的复发，要么是由肝内转移引起，要么是由异时多中心发生所致。肝内转移是伴有不同程度血管侵犯的晚期HCC复发的主要原因，而多中心发生则是无明显血管侵犯的小HCC复发的常见原因。基于在切除的伴有肝硬化的小HCC附近发现被认为是癌前病变的腺瘤样增生（AH）和/或非典型腺瘤样增生（AAH）这一发现，估计至少20%的小HCC因多中心发生而有较高的复发概率。然而，由于在无肝硬化的HCC病例中既不发生AH也不发生AAH，因此非肝硬化肝脏中HCC的大多数复发被认为是由于肝内转移或新发肝癌形成。在一项对伴有小HCC的肝硬化尸检病例的调查中，50%的病例在其他肝切片中发现了更小的HCC结节，据估计，大约50%的HCC在早期就已经是多中心的了。
