Ochiai Toshia, Sonoyama Teruhisa, Ichikawa Daisuke, Fujiwara Hitoshi, Okamoto Kazuma, Sakakura Chohei, Ueda Yuji, Otsuji Eigo, Itoi Hirosumi, Hagiwara Akeo, Yamagishi Hisakazu
Department of Surgery, Division of Digestive Surgery, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Hirokoji-kawaramachi, Kamigyo-ku, 602-8566, Japan.
J Cancer Res Clin Oncol. 2004 Apr;130(4):197-202. doi: 10.1007/s00432-003-0533-8. Epub 2004 Feb 10.
Some patients with hepatocellular carcinoma (HCC) at an early stage cannot attain long-term survival after hepatectomy. The aim of the present study was to investigate the poor prognostic factors for hepatectomy in patients with resectable small HCC with cirrhosis.
We studied 95 patients with cirrhosis with HCC, which consisted of a single tumor 5 cm or smaller or two or three tumor nodules each 3 cm or less; an absence of extrahepatic metastasis; and an absence of radiological evidence of macroscopic portal vein or hepatic vein invasion. We used Cox's proportional hazard model to identify risk factors associated with prognosis to determine the contra-indications for hepatectomy in patients with resectable small HCC.
Preoperative risk factors were: (1) serum AFP concentration of more than 400 ng/ml; (2) infiltrative-, massive-, or multinodular-type (multiple) HCC; and (3) the presence of intrahepatic metastasis. Patients who had had more than one of the three preoperative risk factors were poor candidates for hepatic resection, with a 4-year survival of 16.3%.
If patients with resectable small HCC are diagnosed as having more than one of three preoperative risk factors, they should not receive hepatectomy or should be considered for primary liver transplantation as a therapeutic option for HCC.
部分早期肝细胞癌（HCC）患者肝切除术后无法获得长期生存。本研究旨在探讨可切除的小肝癌合并肝硬化患者肝切除预后不良的因素。
我们研究了95例HCC合并肝硬化患者，这些患者符合以下条件：单个肿瘤直径5 cm或更小，或两到三个肿瘤结节，每个结节直径3 cm或更小；无肝外转移；无门静脉或肝静脉侵犯的影像学证据。我们使用Cox比例风险模型来识别与预后相关的危险因素，以确定可切除的小肝癌患者肝切除的禁忌证。
术前危险因素为：（1）血清甲胎蛋白（AFP）浓度超过400 ng/ml；（2）浸润型、巨块型或多结节型（多发）HCC；（3）存在肝内转移。有上述三种术前危险因素中一种以上的患者不适合肝切除，其4年生存率为16.3%。
如果可切除的小肝癌患者被诊断为具有上述三种术前危险因素中的一种以上，他们不应接受肝切除，或应考虑将原位肝移植作为HCC的一种治疗选择。
