Ercolani Giorgio, Grazi Gian Luca, Ravaioli Matteo, Del Gaudio Massimo, Gardini Andrea, Cescon Matteo, Varotti Giovanni, Cetta Francesco, Cavallari Antonino
Department of Surgery and Transplantation, Surgical Unit, S. Orsola Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
Ann Surg. 2003 Apr;237(4):536-43. doi: 10.1097/01.SLA.0000059988.22416.F2.
To evaluate prognostic factors that could affect disease-free survival and recurrence after liver resection for hepatocellular carcinoma (HCC) on cirrhosis.
Tumor recurrence is the main cause of poor survival after liver resection for HCC on cirrhosis.
Two hundred twenty-four liver resections for HCC on cirrhosis were retrospectively reviewed. Univariate and multivariate analyses were performed on several clinicopathologic variables to analyze factors affecting long-term outcome and intrahepatic recurrence. The relation between preoperative aminotransferase level and recurrence rate was evaluated in the overall group, and separately in HCV-positive and in HBsAg-positive patients. Median follow-up was 35.6 months.
The 1-, 3-, and 5-year overall survival rates were 83%, 62.8%, and 42.5%, respectively. The 1-, 3-, and 5-year disease-free survival rates were 70.3%, 43%, and 27.4%, respectively. The 1-, 3-, and 5-year recurrence rates were 20.8%, 38.6%, and 54.4% respectively. Tumor recurrence appeared in 93 patients (41.5%) and was the main cause of death in 51 patients (56%). Number of nodules, tumor capsule, microvascular portal vein thrombosis, and preoperative serum aspartate aminotransferase (AST) level significantly affected disease-free survival and recurrence rates. On multivariate analysis, single nodules and preoperative AST level less than twice normal (2N) were related to a better 5-year disease-free survival and lower tumor recurrence. In particular, among HCV-positive patients the recurrence rate was strongly affected by the preoperative AST level.
Child A patients with single nodules are the best candidates for liver resection. Tumor recurrence is strictly linked to the status of the underlying liver disease, and a preoperative AST level equal to 2N seems to be a sensitive cutoff among patients with different risks of recurrence. HCV-positive patients with AST levels above 2N have the highest risk for intrahepatic recurrence and should be monitored carefully or offered alternative treatments.
评估可能影响肝硬化患者肝细胞癌（HCC）肝切除术后无病生存期和复发的预后因素。
肿瘤复发是肝硬化患者HCC肝切除术后生存率低的主要原因。
回顾性分析224例肝硬化患者HCC肝切除术。对多个临床病理变量进行单因素和多因素分析，以分析影响长期预后和肝内复发的因素。在总体人群中评估术前转氨酶水平与复发率的关系，并分别在HCV阳性和HBsAg阳性患者中进行评估。中位随访时间为35.6个月。
1年、3年和5年总生存率分别为83%、62.8%和42.5%。1年、3年和5年无病生存率分别为70.3%、43%和27.4%。1年、3年和5年复发率分别为20.8%、38.6%和54.4%。93例患者（41.5%）出现肿瘤复发，51例患者（56%）因肿瘤复发死亡。结节数量、肿瘤包膜、微血管门静脉血栓形成和术前血清天冬氨酸转氨酶（AST）水平显著影响无病生存期和复发率。多因素分析显示，单结节和术前AST水平低于正常上限2倍（2N）与更好的5年无病生存期和更低的肿瘤复发相关。特别是，在HCV阳性患者中，复发率受术前AST水平的强烈影响。
Child A级单结节患者是肝切除的最佳候选人。肿瘤复发与潜在肝病的状况密切相关，术前AST水平等于2N似乎是不同复发风险患者中的一个敏感临界值。AST水平高于2N的HCV阳性患者肝内复发风险最高，应密切监测或提供替代治疗。
