Si Ming-Sing, Amersi Farin, Golish S Raymond, Ortiz Jorge A, Zaky Joseph, Finklestein Debbie, Busuttil Ronald W, Imagawa David K
UCI Medical Center, Department of Surgery, Section of Hepatobiliary and Pancreas Surgery and Islet Cell Transplantation, Orange, California 92868, USA.
Am Surg. 2003 Oct;69(10):879-85.
The purpose of this study was to determine the prevalence and risk factors of metastases in hepatocellular carcinoma (HCC) patients and analyze the effects of different locations of metastases on survival. Retrospective analysis was performed on 347 HCC patients who received a metastatic workup including bone scan and computed tomography scans of chest, abdomen, and pelvis. Clinical and tumor characteristics were evaluated as risk factors for metastasis by univariate and multivariate methods. Survival was analyzed by Kaplan-Meier and Cox regression methods. One hundred forty-five patients had metastases: 72 had thoracic, 57 had abdominal, and 34 had bone metastases. Significant differences were noted with weight loss, hepatitis C, tumor grade, tumor multifocality, size, and alkaline phosphatase levels between the metastases group and the nonmetastases group by univariate analysis. Poor differentiation, multilobar spread, and size (> or = 5 cm) were strongest predictors of metastatic disease by logistic regression. Patients with thoracic metastases had significantly poorer survival. HCC metastasis is prevalent on initial presentation. Evaluation for liver transplantation or curative resection requires a full metastatic workup. Poor differentiation, larger tumors, and those with multilobar spread have increased risk for metastasis. Patients with thoracic spread have poor prognosis as compared to other locations of metastasis.
本研究的目的是确定肝细胞癌（HCC）患者转移的发生率和危险因素，并分析不同转移部位对生存的影响。对347例接受包括骨扫描以及胸部、腹部和骨盆计算机断层扫描在内的转移灶检查的HCC患者进行回顾性分析。通过单因素和多因素方法评估临床和肿瘤特征作为转移的危险因素。采用Kaplan-Meier法和Cox回归法分析生存情况。145例患者发生转移：72例有胸部转移，57例有腹部转移，34例有骨转移。单因素分析显示，转移组和非转移组在体重减轻、丙型肝炎、肿瘤分级、肿瘤多灶性、大小以及碱性磷酸酶水平方面存在显著差异。通过逻辑回归分析，低分化、多叶扩散和大小（≥5 cm）是转移疾病最强的预测因素。有胸部转移的患者生存情况明显较差。HCC转移在初次就诊时很常见。肝移植或根治性切除的评估需要全面的转移灶检查。低分化、较大肿瘤以及多叶扩散的患者转移风险增加。与其他转移部位相比，有胸部扩散的患者预后较差。
