Wakabayashi Hisao, Ushiyama Takafumi, Ishimura Ken, Izuishi Kunihiko, Karasawa Yukihiko, Masaki Tsutomu, Watanabe Seishiro, Kuriyama Shigeki, Maeta Hajime
Department of Surgery, Takamatsu National Hospital, Takamatsu-city, Kagawa, Japan.
J Surg Oncol. 2003 Feb;82(2):98-103. doi: 10.1002/jso.10203.
By comparing the survival rates of patients treated with or without surgery, the significance of, and the indication for, reduction surgery in the multidisciplinary treatment of patients with HCC with multiple intrahepatic lesions were examined.
In patients with HCC with multiple intrahepatic lesions, cumulative survival rates were determined and compared for 28 patients (group S) who underwent reductive hepatic resection and 43 (group N) who were treated nonsurgically by transcatheter arterial infusion chemotherapy (TAI), transcatheter arterial chemoembolization (TACE), or percutaneous transhepatic ethanol injection therapy. In group S, 20 patients had adjuvant therapy, consisting of ethanol injection therapy or microwave coagulonecrotic therapy for the remaining satellite lesions during hepatectomy, and all patients in this group underwent TAI or TACE postoperatively. The influence of surgery on patient survival was examined by multiple regression analysis using the Cox's hazard model; then, for each prognostic factor, survival rates were obtained and compared between the groups.
In group S, the 1-, 3-, and 5-year cumulative survival rates were 58.2%, 27.1%, and 21.7%, whereas the corresponding values in group N were 34.3%, 4.7%, and 4.7%, the difference being statistically significant (P = 0.0239). In group S, the 1-, 3-, and 5-year cumulative survival rates for patients without intraoperative adjuvant therapy were 25%, 0%, and 0%, whereas those for patients with intraoperative adjuvant therapy were 72.7%, 41.3%, and 33.0% (P = 0.001). Multiple regression analysis showed that hepatic resection, the Child-Pugh score, and the size of the main tumor affected survival independently. Univariate analysis of differences in the cumulative survival rates between the groups as a function of prognostic factor showed that group S had statistically significant better survival rates than group N in those subgroups of patients who were <60 years old, with HBV infection, with a Child-Pugh score of 5 or 6, with a main tumor of <5-cm diameter, with <5 tumors, or without portal thrombi.
When combined with intraoperative adjuvant therapy for remaining satellite tumors, reduction surgery provided survival benefit for patients with HCC with multiple intrahepatic lesions in those groups of patients selected by criteria determined in this study.
通过比较接受或未接受手术治疗患者的生存率，探讨在多学科治疗肝内多发 HCC 患者中进行缩小手术的意义及指征。
在肝内多发 HCC 患者中，测定并比较 28 例行肝切除缩小手术的患者（S 组）和 43 例接受经动脉化疗栓塞（TAI）、经动脉化疗栓塞（TACE）或经皮肝穿刺乙醇注射治疗的非手术治疗患者（N 组）的累积生存率。在 S 组中，20 例患者接受辅助治疗，包括肝切除术中对剩余卫星灶行乙醇注射治疗或微波凝固坏死治疗，且该组所有患者术后均接受 TAI 或 TACE 治疗。采用 Cox 风险模型通过多元回归分析研究手术对患者生存的影响；然后，针对每个预后因素，获取并比较两组的生存率。
S 组 1 年、3 年和 5 年累积生存率分别为 58.2%、27.1%和 21.7%，而 N 组相应值分别为 34.3%、4.7%和 4.7%，差异有统计学意义（P = 0.0239）。在 S 组中，未接受术中辅助治疗患者的 1 年、3 年和 5 年累积生存率分别为 25%、0%和 0%，而接受术中辅助治疗患者的相应生存率分别为 72.7%、41.3%和 33.0%（P = 0.001）。多元回归分析显示肝切除、Child-Pugh 评分和主肿瘤大小独立影响生存。对两组间累积生存率差异作为预后因素的函数进行单因素分析显示，在年龄<60 岁、感染 HBV、Child-Pugh 评分为 5 或 6、主肿瘤直径<5 cm、肿瘤数<5 个或无门静脉血栓的患者亚组中，S 组的生存率显著高于 N 组。
当联合术中对剩余卫星肿瘤的辅助治疗时，对于本研究确定标准所选择的肝内多发 HCC 患者亚组，缩小手术可使患者生存获益。
