Laurent Christophe, Blanc Jean Frédéric, Nobili Steeve, Sa Cunha Antonio, le Bail Brigitte, Bioulac-Sage Paulette, Balabaud Charles, Capdepont Maylis, Saric Jean
Department of Surgery, Saint-Andre Hospital, Bordeaux, France.
J Am Coll Surg. 2005 Nov;201(5):656-62. doi: 10.1016/j.jamcollsurg.2005.05.027. Epub 2005 Aug 31.
The incidence of hepatocellular carcinoma (HCC) in cirrhotic and noncirrhotic liver is increasing in the world, probably because of the high prevalence of infections by hepatitis B and C viruses. Despite numerous publications on hepatic resection, prognostic factors for intrahepatic recurrence and survival are not well known for patients with HCC without cirrhosis.
One hundred eight consecutive patients with HCC in noncirrhotic liver have been treated by hepatic resection in the past 18 years in our center. Clinical, biologic, and histopathologic parameters of these patients were collected. Risk factors for intrahepatic recurrence and prognostic factors for survival were evaluated by univariate and multivariate analyses.
Postoperative morbidity and mortality rates were 23% and 6.5%, respectively. The 3- and 5-year disease-free and overall survival rates were 55% and 43%, and 43% and 29%, respectively. Blood transfusion, absence of tumor capsule, and daughter nodules were independently associated with overall survival. But the only risk factors for recurrence were blood transfusion, absence of tumor capsule, daughter nodules, and margin resection < 10 mm.
In the treatment of HCC without cirrhosis, hepatectomy remains a safe and legitimate treatment, but longterm results are impaired by a high rate of early recurrence likely related to metastatic dissemination. Only histopathologic factors related to the tumor are predictive of recurrence and overall survival.
在全球范围内，肝硬化和非肝硬化肝脏中肝细胞癌（HCC）的发病率都在上升，这可能是由于乙型和丙型肝炎病毒感染的高流行率所致。尽管有大量关于肝切除术的文献，但对于非肝硬化HCC患者，肝内复发和生存的预后因素尚不明确。
在过去18年中，我们中心对108例连续的非肝硬化肝脏HCC患者进行了肝切除术。收集了这些患者的临床、生物学和组织病理学参数。通过单因素和多因素分析评估肝内复发的危险因素和生存的预后因素。
术后发病率和死亡率分别为23%和6.5%。3年和5年无病生存率及总生存率分别为55%和43%，43%和29%。输血、无肿瘤包膜和子结节与总生存独立相关。但复发的唯一危险因素是输血、无肿瘤包膜、子结节和切缘<10mm。
在非肝硬化HCC的治疗中，肝切除术仍然是一种安全合理的治疗方法，但长期结果受到可能与转移播散相关的高早期复发率的影响。只有与肿瘤相关的组织病理学因素可预测复发和总生存。
