Shimozawa Nobuhiko, Hanazaki Kazuhiro
Second Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
J Am Coll Surg. 2004 Mar;198(3):356-65. doi: 10.1016/j.jamcollsurg.2003.10.017.
Treatment of small hepatocellular carcinoma (HCC) remains a critical issue. In addition, the longterm prognosis and prognostic factors of small hepatocellular carcinoma after hepatic resection are not well documented.
The surgical outcomes of 135 consecutive patients with one to three HCCs of diameter <or= 3 cm who underwent curative hepatic resection between 1987 and 2001 were reviewed retrospectively. Postresection prognostic factors were evaluated by univariate and multivariate analysis using Cox's proportional hazards model.
The overall incidence of postoperative complications was 25%, and three patients had hospital deaths (2%), including one (0.7%) operative death. The mean and median overall survival times, including hospital death after surgery, were 53 months and 43 months, respectively. The 3-, 5-, and 10-year disease-free survival percentages after hepatic resection were 49%, 30%, and 8%, respectively. The 3-, 5-, and 10-year overall survival percentages after hepatic resection were 73%, 55%, and 18%, respectively. Multivariate analysis revealed that age more than 60 years was an independent unfavorable prognostic factor affecting disease-free survival (hazard ratio 1.286, 95% confidence interval 1.107 to 1.863, p = 0.046), and the presence of liver cirrhosis was an independently significant factor of poor overall survival (hazard ratio 2.012, 95% confidence interval 1.049 to 3.861, p = 0.035). The cumulative incidence of postoperative recurrence was 82%. The 5-year overall survival in patients with tumor recurrence undergoing repeat hepatectomy (85%) was significantly greater than in patients without second resection (41%). Six patients (4%) survived longer than 10 years after hepatic resection (four with recurrence and two without recurrence). All four of these patients with postoperative recurrence underwent repeat hepatectomy.
The postresection survival of patients with small hepatocellular carcinoma will differ depending on the presence of liver cirrhosis. Repeat hepatectomy may contribute to the prolongation of survival in such patients with postoperative recurrence.
小肝细胞癌（HCC）的治疗仍然是一个关键问题。此外，肝切除术后小肝细胞癌的长期预后及预后因素尚无充分记录。
回顾性分析1987年至2001年间连续135例直径≤3cm的一至三个HCC患者接受根治性肝切除的手术结果。采用Cox比例风险模型通过单因素和多因素分析评估切除术后的预后因素。
术后并发症的总发生率为25%，3例患者死亡（2%），包括1例（0.7%）手术死亡。包括术后住院死亡在内的平均和中位总生存时间分别为53个月和43个月。肝切除术后3年、5年和10年无病生存率分别为49%、30%和8%。肝切除术后3年、5年和10年总生存率分别为73%、55%和18%。多因素分析显示，年龄超过60岁是影响无病生存的独立不良预后因素（风险比1.286，95%置信区间1.107至1.863，p = 0.046），而肝硬化的存在是总生存不良的独立显著因素（风险比2.012，95%置信区间1.049至3.861，p = 0.035）。术后复发的累积发生率为82%。接受再次肝切除的肿瘤复发患者的5年总生存率（85%）显著高于未进行二次切除的患者（41%）。6例患者（4%）肝切除术后存活超过10年（4例复发，2例未复发）。所有这4例术后复发患者均接受了再次肝切除。
小肝细胞癌患者切除术后的生存情况因肝硬化的存在与否而有所不同。再次肝切除可能有助于延长此类术后复发患者的生存时间。
