Imamura Hiroshi, Matsuyama Yutaka, Tanaka Eiji, Ohkubo Takao, Hasegawa Kiyoshi, Miyagawa Shinichi, Sugawara Yasuhiko, Minagawa Masami, Takayama Tadatoshi, Kawasaki Seiji, Makuuchi Masatoshi
Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
J Hepatol. 2003 Feb;38(2):200-7. doi: 10.1016/s0168-8278(02)00360-4.
BACKGROUND/AIMS: We conducted a retrospective cohort study to investigate factors to early and late phase recurrence of hepatocellular carcinoma (HCC).
The study population consisted of 249 patients including 157 with cirrhosis who underwent hepatectomy for HCC. The endpoint was time-to-recurrence. Using a Cox regression model, factors to early and late phase recurrences were investigated censoring recurrence-free patients at the 2-year time point and in patients without recurrence at 2 years.
Actuarial probability of overall recurrence at 1, 3, and 5 years were 0.301, 0.623, and 0.790, respectively, with a median follow-up of 624 days. Early recurrence was observed in 123 out of 249 patients; while late recurrence was found in 61 out of 113 patients. Factors to early recurrence were as follows: non-anatomical resection, presence of microscopic vascular invasion, and serum alpha-fetoprotein level >or=32 ng/ml. Those contributing to late phase recurrence were higher grade of hepatitis activity, multiple tumors, and gross tumor classification.
Variables associated with metastatic recurrence were factors to early phase recurrence; whereas those related with elevated carcinogenesis contributed to late phase recurrence, thus providing an epidemiological evidence that different mechanisms, i.e. metastasis and de novo, are involved in intrahepatic recurrence after hepatectomy for HCC.
背景/目的：我们进行了一项回顾性队列研究，以调查肝细胞癌（HCC）早期和晚期复发的因素。
研究人群包括249例患者，其中157例肝硬化患者接受了HCC肝切除术。终点是复发时间。使用Cox回归模型，在2年时间点对无复发患者以及2年时未复发的患者进行审查，研究早期和晚期复发的因素。
中位随访624天，1年、3年和5年的总复发精算概率分别为0.301、0.623和0.790。249例患者中有123例出现早期复发；而113例患者中有61例出现晚期复发。早期复发的因素如下：非解剖性切除、存在微小血管侵犯以及血清甲胎蛋白水平≥32 ng/ml。导致晚期复发的因素是更高的肝炎活动度、多发肿瘤和大体肿瘤分类。
与转移复发相关的变量是早期复发的因素；而与致癌作用增强相关的变量导致晚期复发，从而提供了流行病学证据，表明不同机制，即转移和新发，参与了HCC肝切除术后的肝内复发
