Capussotti L, Muratore A, Amisano M, Massucco P, Polastri R, Bouzari H
Unit of Surgical Oncology, IRCC, Torino, Italy.
Hepatogastroenterology. 2006 Sep-Oct;53(71):768-72.
BACKGROUND/AIMS: Few reports have analyzed short- and long-term outcomes in the subset of patients with hepatocellular carcinoma (HCC) on non-cirrhotic liver.
From January 1985 to December 2002, 277 patients underwent liver resection for HCC; in only 47 the liver was normal or showed mild chronic hepatitis at histology.
A major hepatectomy (MHR) was accomplished in 37 cases (78.7%) including an extended hepatic resection in 18 (38.3%). In-hospital mortality was nil. The rate of complications was 40.4%. Overall and disease-free survival rates at 5 years were 30.9% and 33.9%. Fifteen patients are actually alive with a median survival of 33.3 months. By multivariate analysis, tumor size > 10cm and presence of satellite nodules were independent predictive factors of 5-year survival; median survival of thirteen patients with HCCs < or = 10cm and without daughter nodules was 60 months. Twenty-six patients had a margin less than 1cm and without cancer involvement; overall and recurrence-free survival rates were comparable to those of the patients with a > 1cm margin.
In the treatment of HCC without cirrhosis, major hepatic resections are often needed. Tumors less than 10cm in size and without satellite nodes are the best candidates for operation. The width of the resection margin is unimportant provided that there is no microscopic infiltration.
背景/目的：很少有报告分析非肝硬化性肝的肝细胞癌（HCC）患者的短期和长期预后。
1985年1月至2002年12月，277例患者因HCC接受肝切除术；其中仅47例肝脏在组织学上正常或显示轻度慢性肝炎。
37例（78.7%）完成了大肝切除术（MHR），其中18例（38.3%）为扩大肝切除术。住院死亡率为零。并发症发生率为40.4%。5年总生存率和无病生存率分别为30.9%和33.9%。15例患者仍存活，中位生存期为33.3个月。多因素分析显示，肿瘤大小>10cm和存在卫星结节是5年生存的独立预测因素；13例肿瘤大小≤10cm且无子结节的HCC患者的中位生存期为60个月。26例患者切缘小于1cm且无癌浸润；总生存率和无复发生存率与切缘>1cm的患者相当。
在无肝硬化的HCC治疗中，常需要进行大肝切除术。肿瘤大小小于10cm且无卫星结节是最佳手术候选者。只要没有微小浸润，切缘宽度并不重要。
