Nakagawa Takahito, Kamiyama Toshiya, Nakanishi Kazuaki, Yokoo Hideki, Kamachi Hirofumi, Matsushita Michiaki, Todo Satoru
Department of General Surgery, Hokkaido University, Graduate School of Medicine, Sapporo, Japan.
J Thorac Cardiovasc Surg. 2006 Jun;131(6):1248-54. doi: 10.1016/j.jtcvs.2006.02.009.
Although the lung is the most common site of extrahepatic spread from hepatocellular carcinoma, outcomes after pulmonary resection and prognostic factors have not been well described. We analyzed a single-center experience with 25 patients undergoing pulmonary resection of metastases from hepatocellular carcinoma to examine the clinical factors and outcomes.
Patients were candidates for resection if they had controlled intrahepatic disease with no evidence of extrathoracic lesions and if all gross tumors could be removed with preservation of respiratory function. Twenty-five patients with hepatocellular carcinoma who underwent curative hepatectomy were suitable for the pulmonary resection criteria between 1990 and 2005. Clinical features and outcomes were analyzed.
The mean actuarial 1-, 3-, and 5-year survivals after pulmonary resection were 80%, 61%, and 36%, respectively. Tumor number (solitary or multiple) and location (unilateral or bilateral lung) did not significantly affect cancer-specific survival. Mean 5-year survival was 25% for patients with disease-free interval of 1 to 11 months and 62% for those with disease-free interval of 12 months or more. Mean survival was 15.9 months for patients with alpha-fetoprotein of 500 ng/mL or more, and 39.2 months for those with alpha-fetoprotein less than 500 ng/mL. Five-year survival was 21% for patients with short disease-free interval or high alpha-fetoprotein level and 74% for those with long disease-free interval and low alpha-fetoprotein level (P = .015).
Pulmonary resection for metastases from hepatocellular carcinoma may prolong survival in selected patients. Disease-free interval greater than 12 months and alpha-fetoprotein less than 500 ng/mL are important prognostic factors.
虽然肺是肝细胞癌肝外转移最常见的部位，但肺切除术后的结果及预后因素尚未得到充分描述。我们分析了单中心25例接受肝细胞癌肺转移灶切除术患者的情况，以研究临床因素及手术结果。
如果患者肝内疾病得到控制，无胸外病变证据，且所有肉眼可见肿瘤均可切除并保留呼吸功能，则可作为切除手术的候选对象。1990年至2005年间，25例行根治性肝切除术的肝细胞癌患者符合肺切除标准。分析其临床特征及手术结果。
肺切除术后1年、3年和5年的精算生存率分别为80%、61%和36%。肿瘤数量（单发或多发）及位置（单侧或双侧肺）对癌症特异性生存率无显著影响。无病间期为1至11个月的患者5年平均生存率为25%，无病间期为12个月或更长时间的患者为62%。甲胎蛋白≥500 ng/mL的患者平均生存期为15.9个月，甲胎蛋白＜500 ng/mL的患者为39.2个月。无病间期短或甲胎蛋白水平高的患者5年生存率为21%，无病间期长且甲胎蛋白水平低的患者为74%（P = 0.015）。
对肝细胞癌转移灶进行肺切除可能会延长部分患者的生存期。无病间期大于12个月及甲胎蛋白小于500 ng/mL是重要的预后因素。
