Hanazaki Kazuhiro, Matsushita Akimasa, Nakagawa Kan, Misawa Ryosuke, Amano Jun
Second Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Hepatogastroenterology. 2005 Mar-Apr;52(62):580-6.
BACKGROUND/AIMS: Although the risk factors for the development of intrahepatic recurrence after hepatectomy for hepatocellular carcinoma (HCC) have been widely studied, little attention has been given to the prognostic factors affecting such patients.
Intrahepatic recurrence occurred in 105 (56%) of 188 patients who underwent curative hepatic resection of HCC and were discharged from the hospital. Among them, 17 (16%) also had simultaneous extrahepatic recurrence. Independent prognostic factors were evaluated by multivariate analysis using Cox's proportional hazards model.
Multivariate analysis revealed that presence of extrahepatic recurrence, hepatitis B, and non-surgical treatments for recurrence were independent predictors of poor overall survival after initial hepatic resection or after recurrence. Risk factors of extrahepatic recurrence were young age, solitary and large HCC, high hepatitis activity, and large amount of intraoperative blood loss and blood transfusion.
Survival of patients with intrahepatic recurrent HCC after resection should be stratified by the type of recurrence, type of hepatitis, and type of treatment for recurrence.
背景/目的：虽然肝细胞癌（HCC）肝切除术后肝内复发的危险因素已得到广泛研究，但对影响此类患者的预后因素关注较少。
188例行根治性肝切除治疗HCC并出院的患者中，105例（56%）发生肝内复发。其中，17例（16%）同时伴有肝外复发。采用Cox比例风险模型进行多因素分析，评估独立预后因素。
多因素分析显示，肝外复发、乙型肝炎以及复发时采用非手术治疗是初次肝切除术后或复发后总体生存不良的独立预测因素。肝外复发的危险因素包括年轻、孤立性大肝癌、肝炎活动度高、术中失血量及输血量多。
肝切除术后肝内复发HCC患者的生存情况应根据复发类型、肝炎类型及复发治疗方式进行分层。
