Ramacciato G, Mercantini P, Corigliano N, Cautero N, Masetti M, Di Benedetto F, Quintini C, Balducci G, Siniscalchi A, Begliomini B, Ziparo V, Pinna A
University of Rome La Sapienza, II Faculty of Medicine and Surgery, Azienda Ospedaliera Sant'Andrea, UOC Chirurgia A, Italy.
J Exp Clin Cancer Res. 2003 Dec;22(4 Suppl):233-41.
To evaluate the short and long term outcome of liver resections for hepatocellular carcinoma in cirrhotic patients. A retrospective analysis was performed on 106 consecutive cirrhotic patients with hepatocellular carcinoma resected between June 1974 and September 2002 at the Department of Surgery "Pietro Valdoni" - University of Rome "La Sapienza" and at the Liver and Multivisceral Transplant Unit of the University of Modena. Univariate and multivariate analyses were performed on several clinicopathological variables to analyze factors affecting the long-term outcome and intrahepatic recurrence. Overall mortality and morbidity were 10.7% and 26% respectively. These rates significantly decreased in the last years: from 1997 to 2002 no hospital mortality has been recorded. After a median follow-up of 19 months (interquartile range: 10-36), tumour recurrence appeared in 25 patients (23,5%). The 1-, 3-, and 5-year overall survival rates were 86,6%, 70,3%, and 60,6%, respectively. The 1-, 3-, and 5-year disease-free survival rates were 86,3%, 58,1%, and 40,7%. On univariate analysis, viral ethiology of cirrhosis (p=0.03), presence of multiple nodules (p=0.02) and vascular invasion (p=0.05) were found to be related to a worse long-term survival. At the multivariate analysis only the viral ethiology of cirrhosis and the presence of multiple nodules were confirmed as indipendent prognostic factors. Early results after hepatic resection for HCC can be improved by using a limited surgical approach. The viral ethiology of cirrhosis, the presence of multiple nodules and vascular invasion negatively affected recurrence rate and long-term survival.
评估肝硬化患者肝细胞癌肝切除的短期和长期预后。对1974年6月至2002年9月期间在罗马“萨皮恩扎”大学“彼得罗·瓦尔托尼”外科以及摩德纳大学肝脏和多脏器移植科连续接受肝切除的106例肝硬化肝细胞癌患者进行回顾性分析。对多个临床病理变量进行单因素和多因素分析，以分析影响长期预后和肝内复发的因素。总体死亡率和发病率分别为10.7%和26%。近年来这些比率显著下降：1997年至2002年未记录到医院死亡病例。中位随访19个月（四分位间距：10 - 36个月）后，25例患者（23.5%）出现肿瘤复发。1年、3年和5年总生存率分别为86.6%、70.3%和60.6%。1年、3年和5年无病生存率分别为86.3%、58.1%和40.7%。单因素分析发现，肝硬化的病毒病因（p = 0.03）、多发结节的存在（p = 0.02）和血管侵犯（p = 0.05）与较差的长期生存相关。多因素分析仅证实肝硬化的病毒病因和多发结节的存在为独立预后因素。采用有限的手术方法可改善肝癌肝切除后的早期结果。肝硬化的病毒病因、多发结节的存在和血管侵犯对复发率和长期生存产生负面影响。
