直径大于或等于10厘米的肝细胞癌的肝切除术

Hepatic resection for hepatocellular carcinoma in diameter of > or = 10 cm.

作者信息

Hanazaki Kazuhiro, Kajikawa Shoji, Shimozawa Nobuhiko, Shimada Ko, Hiraguri Manabu, Koide Naohiko, Adachi Wataru, Amano Jun

机构信息

Second Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.

出版信息

Hepatogastroenterology. 2002 Mar-Apr;49(44):518-23.

PMID:11995486

Abstract

BACKGROUND/AIMS: Definitive efficacy of hepatic resection for hepatocellular carcinoma larger than or equal to 10 cm in diameter remains to be resolved.

METHODOLOGY

The surgical outcomes in 33 consecutive patients with hepatocellular carcinoma in diameter of > or = 10 cm who underwent hepatic resection were retrospectively clarified. Postresection prognostic factors were evaluated by univariate and multivariate analysis using Cox's proportional hazards model.

RESULTS

The overall incidence of postoperative complications was 39%, and 5 patients among them had hospital deaths (15%) including 2 (6%) operative deaths. The 3-year, 5-year, and 9-year overall survival rates after hepatic resection were 32%, 27%, and 17%, respectively. Univariate analysis revealed that liver cirrhosis and stage IV-A (pTNM staging) were significant factors of poor overall survival. By Cox's proportional hazards model, liver cirrhosis was an independently unfavorable prognostic factor of long-term survival. Hospital mortality rate in patients with cirrhosis was 31%. The 5-year overall survival rate in patients with cirrhosis (7%) was significantly shorter than that in patients without cirrhosis (43%) (P = 0.006). In addition, the 5-year overall survival rate in patients with stage IV-A (11%) was significantly shorter than that in patients with stage II and III (48%) (P = 0.024). The incidence of stage IV-A in patients with cirrhosis (77%) was significantly higher than those without cirrhosis (35%) (P = 0.032).

CONCLUSIONS

Hepatic resection for hepatocellular carcinoma in diameter of > or = 10 cm was effective for patients without liver cirrhosis and with stage II or III. Appropriate selection of the candidates for partial hepatectomy based on the above prognostic factors may play an important role in the improvement of high mortality rate and poor long-term survival for such patients. Prospective randomized trials are needed to define the role of hepatic resection for cirrhotic patients with large HCC.

摘要

背景/目的：直径大于或等于10cm的肝细胞癌肝切除的最终疗效仍有待确定。

方法

回顾性分析33例直径大于或等于10cm的肝细胞癌患者接受肝切除术后的手术结果。采用Cox比例风险模型进行单因素和多因素分析，评估术后预后因素。

结果

术后并发症总发生率为39%，其中5例患者死亡（15%），包括2例手术死亡（6%）。肝切除术后3年、5年和9年的总生存率分别为32%、27%和17%。单因素分析显示，肝硬化和IV-A期（pTNM分期）是总生存不良的显著因素。根据Cox比例风险模型，肝硬化是长期生存的独立不良预后因素。肝硬化患者的医院死亡率为31%。肝硬化患者的5年总生存率（7%）显著低于无肝硬化患者（43%）（P = 0.006）。此外，IV-A期患者的5年总生存率（11%）显著低于II期和III期患者（48%）（P = 0.024）。肝硬化患者中IV-A期的发生率（77%）显著高于无肝硬化患者（35%）（P = 0.032）。