Belghiti J, Regimbeau J M, Durand F, Kianmanesh A R, Dondero F, Terris B, Sauvanet A, Farges O, Degos F
Department of Hepatobiliary and Digestive Surgery, Beaujon Hospital, Paris VII University, Clichy, France.
Hepatogastroenterology. 2002 Jan-Feb;49(43):41-6.
BACKGROUND/AIMS: Surgical liver resection has been demonstrated in Asian countries to be the best therapeutic option in patients with hepatocellular carcinoma. Because the value of this treatment is still debated in Western countries, the aim of this paper was to report a European experience of resection for hepatocellular carcinoma.
From 1990 to 1999, 239 men and 61 women aged from 15 to 77 years old underwent 328 resections including major resection in 138 (42%) cases. Normal liver was present in 53 patients (17%) and chronic liver disease was present in 247 including 152 (50%) with cirrhosis.
In-hospital mortality was 6.4% and was significantly influenced by the presence of chronic liver disease (1.7% vs. 7.4%). Mortality after resection in alcoholic patients (14%), in patients with hepatitis C (9%) was significantly higher than in patients chronic hepatitis B (1%) (P < 0.05). The overall survival rates were 81%, 57%, 37%, and 13% at 1, 3, 5 and 10 years. Five-year survival rate was significantly higher (P < 0.05) in patients with normal liver as compared to chronic liver disease (50% vs. 34%). In patients with chronic liver disease parameters, which significantly influenced survival rate, were vascular invasion, tumor differentiation and the extent of resection.
In this European study with varied profile of etiologies associated with hepatocellular carcinoma we showed that a five-year survival rate of 40% can be expected after resection and that chronic liver disease is a major factor influencing short and long-term prognosis.
背景/目的：在亚洲国家，手术肝切除已被证明是肝细胞癌患者的最佳治疗选择。由于这种治疗方法在西方国家的价值仍存在争议，本文旨在报告欧洲肝细胞癌切除术的经验。
1990年至1999年，239名男性和61名女性，年龄在15至77岁之间，接受了328例切除术，其中138例（42%）为大手术。53例患者（17%）肝脏正常，247例存在慢性肝病，其中152例（50%）患有肝硬化。
住院死亡率为6.4%，慢性肝病的存在对其有显著影响（1.7%对7.4%）。酒精性肝病患者（14%）、丙型肝炎患者（9%）切除术后的死亡率显著高于慢性乙型肝炎患者（1%）（P<0.05）。1年、3年、5年和10年的总生存率分别为81%、57%、37%和13%。与慢性肝病患者相比，肝脏正常的患者5年生存率显著更高（P<0.05）（50%对34%）。在慢性肝病患者中，显著影响生存率的参数是血管侵犯、肿瘤分化和切除范围。
在这项病因多样的欧洲肝细胞癌研究中，我们发现切除术后五年生存率可达40%，慢性肝病是影响短期和长期预后的主要因素。
