Zhou Xin-Da, Tang Zhao-You, Ma Zeng-Chen, Wu Zhi-Quan, Fan Jia, Qin Lun-Xiu, Zhang Bo-Heng
The Liver Cancer Institute, Zhong Shan Hospital, Fudan University, 136 Yi Xue Yuan Road, 200032, Shanghai, China.
J Cancer Res Clin Oncol. 2003 Sep;129(9):543-8. doi: 10.1007/s00432-003-0446-6. Epub 2003 Jul 30.
Large primary liver cancer (PLC) more than 10 cm in diameter is not infrequently encountered in clinical practice. This study evaluated the clinicopathological features and long-term results after surgery for large PLC.
Comparison of clinicopathological data between patients with PLC >/=10 cm ( n=1,227) and PLC <10 cm ( n=2,349) during the same period.
In comparison with patients with PLC <10 cm, patients with PLC >/=10 cm were significantly younger ( P<0.01), had a lower incidence of asymptomatic tumors (9.1% vs 39.5%, P<0.001), higher alpha-fetoprotein levels ( >400 ng/ml, 78.3% vs 49.2%, P<0.001), higher gamma-glutamyl transpeptidase levels ( >6U, 87.7% vs 70.5%, P<0.001), a lower incidence of a history of hepatitis (45.0% vs 61.4%, P<0.001) and associated macronodular cirrhosis (cirrhotic nodules >/=0.3 cm, 59.8% vs 66.6%, P<0.001), poor differentiation of tumor cells (Edmondson grade 3-4, 24.3% vs 19.7%, P<0.01), a lower percentage of single nodule tumors (59.9% vs 75.4%, P<0.001) and well-encapsulated tumors (28.5% vs 62.1%, P<0.001), a higher proportion of tumor emboli in the portal vein (20.5% vs 9.0%, P<0.001), a lower resection rate (50.6% vs 86.8%, P<0.001), a lower curative resection rate (54.8% vs 78.3%, P<0.001), a higher operative mortality rate (4.5% vs 2.3%, P<0.001), and less local resection (52.5% vs 80.2%, P<0.001). The 5- and 10-year survival rates after resection were 26.2% and 17.5%, respectively, for patients with PLC >/=10 cm ( n=621), and 54.3% and 39.5%, respectively, for patients with PLC <10 cm ( n=2039) ( P<0.01).
Large PLC had specific clinicopathological features. Surgery is the first choice of treatment. In selected patients, resection is safe and offers the chance of long-term survival. Large PLC does not exclude the possibility of cure.
临床实践中经常会遇到直径超过10 cm的大型原发性肝癌（PLC）。本研究评估了大型PLC手术后的临床病理特征和长期结果。
比较同期直径≥10 cm（n = 1227）和直径<10 cm（n = 2349）的PLC患者的临床病理数据。
与直径<10 cm的PLC患者相比，直径≥10 cm的PLC患者明显更年轻（P<0.01），无症状肿瘤的发生率更低（9.1%对39.5%，P<0.001），甲胎蛋白水平更高（>400 ng/ml，78.3%对49.2%，P<0.001），γ-谷氨酰转肽酶水平更高（>6U，87.7%对70.5%，P<0.001），肝炎病史的发生率更低（45.0%对61.4%，P<0.001），伴有大结节性肝硬化（肝硬化结节≥0.3 cm，59.8%对66.6%，P<0.001），肿瘤细胞分化差（Edmondson 3-4级，24.3%对19.7%，P<0.01），单结节肿瘤的比例更低（59.9%对75.4%，P<0.001），包膜完整的肿瘤比例更低（28.5%对62.1%，P<0.001），门静脉肿瘤栓子的比例更高（20.5%对9.0%，P<0.001），切除率更低（50.6%对86.8%，P<0.001），根治性切除率更低（54.8%对78.3%，P<0.001），手术死亡率更高（4.5%对2.3%，P<0.001），局部切除更少（52.5%对80.2%，P<0.001）。直径≥10 cm的PLC患者（n = 621）切除术后的5年和10年生存率分别为26.2%和17.5%，直径<10 cm的PLC患者（n = 2039）分别为54.3%和39.5%（P<0.01）。
大型PLC具有特定的临床病理特征。手术是首选治疗方法。在选定的患者中，切除是安全的，并提供长期生存的机会。大型PLC并不排除治愈的可能性。
