Sasaki Y, Imaoka S, Masutani S, Ohashi I, Ishikawa O, Koyama H, Iwanaga T
Department of Surgery, Center for Adult Diseases, Osaka, Japan.
Surgery. 1992 Sep;112(3):515-21.
As one of the reasons for the poor prognosis of patients with hepatocellular carcinoma (HCC) and cirrhosis, the influence of cirrhosis itself has not been clarified.
We compared the postoperative long-term courses of patients with HCC and cirrhosis with the courses of patients with HCC and without cirrhosis to determine how the coexisting cirrhosis affected the prognosis after surgery. The patients with HCC who underwent curative hepatic resection consisted of 142 with associated histologically confirmed cirrhosis and 48 without cirrhosis.
The 5-, 7-, and 9-year survival rates were 44%, 32%, and 26%, respectively, in the patients with cirrhosis and 68%, 57%, and 57%, respectively, in the patients without cirrhosis. The prognosis of the group with cirrhosis was significantly worse than that of the group without cirrhosis. The main cause of death in both groups was cancer recurrence. The patients with cirrhosis had significantly lower recurrence-free survival rates at 3 years and later than had the patients without cirrhosis. A comparison of the background factors revealed no substantive disadvantages with regard to tumor-related and surgical factors in the patients with cirrhosis compared with the patients without cirrhosis. The recurrence-free survival rates after minor and major resection indicated fewer disadvantages of limited hepatectomy in the group with cirrhosis than in the group without cirrhosis. Moreover, the recurrence-free survival of the group with cirrhosis was shorter at less advanced stages than at more advanced stages when compared with that of the group without cirrhosis.
The higher carcinogenic potential in cirrhosis could be presumed to be the most likely reason for the poorer prognosis after surgery in the patients with HCC and cirrhosis.
作为肝细胞癌（HCC）合并肝硬化患者预后不良的原因之一，肝硬化本身的影响尚未明确。
我们比较了HCC合并肝硬化患者与HCC不合并肝硬化患者的术后长期病程，以确定并存的肝硬化如何影响手术后的预后。接受根治性肝切除术的HCC患者包括142例组织学证实合并肝硬化的患者和48例不合并肝硬化的患者。
肝硬化患者的5年、7年和9年生存率分别为44%、32%和26%，不合并肝硬化患者的相应生存率分别为68%、57%和57%。肝硬化组的预后明显差于非肝硬化组。两组的主要死亡原因都是癌症复发。肝硬化患者3年及以后的无复发生存率明显低于非肝硬化患者。对背景因素的比较显示，与非肝硬化患者相比，肝硬化患者在肿瘤相关和手术因素方面没有实质性劣势。小范围和大范围切除后的无复发生存率表明，肝硬化组有限肝切除术的劣势比非肝硬化组少。此外，与非肝硬化组相比，肝硬化组在较早期阶段的无复发生存期比在较晚期阶段短。
可以推测，肝硬化中较高的致癌潜能是HCC合并肝硬化患者术后预后较差的最可能原因。
