Ramacciato Giovanni, Mercantini Paolo, Nigri Giuseppe R, Ravaioli Matteo, Cautero Nicola, Di Benedetto Fabrizio, Masetti Michele, Grazi Gian Luca, Ziparo Vincenzo, Ercolani Giorgio, Pinna Antonio Daniele
Department of General Surgery, Hepato-biliary-pancreatic Unit, University of Rome "La Sapienza" II Faculty of Medicine, Sant'Andrea Hospital, Rome, Italy.
Hepatogastroenterology. 2006 Nov-Dec;53(72):898-903.
BACKGROUND/AIMS: Evaluation of the short- and long-term outcome of liver resections for HCC in cirrhotic patients.
A retrospective analysis was performed on 106 consecutive cirrhotic patients with HCC resected between June 1974 and September 2002. 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), tumor 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%. Univariate analysis showed that viral etiology of cirrhosis (p=0.03), presence of multiple nodules (p=0.02) and vascular invasion (p=0.05) are related to a worse long-term survival. Multivariate analysis showed that only the viral etiology of cirrhosis and the presence of multiple nodules were significant independent prognostic factors.
Results after hepatic resection for HCC in cirrhotic patients can be improved by using a limited surgical approach. The viral etiology of cirrhosis, the presence of multiple nodules and vascular invasion negatively affected recurrence rate and long-term survival.
背景/目的：评估肝硬化患者肝癌肝切除的短期和长期预后。
对1974年6月至2002年9月期间连续切除肝癌的106例肝硬化患者进行回顾性分析。对几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年无医院死亡记录。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%。单因素分析显示，肝硬化的病毒病因（p = 0.03）、多结节存在（p = 0.02）和血管侵犯（p = 0.05）与较差的长期生存相关。多因素分析显示，只有肝硬化的病毒病因和多结节存在是显著的独立预后因素。
采用有限的手术方法可改善肝硬化患者肝癌肝切除后的结果。肝硬化的病毒病因、多结节存在和血管侵犯对复发率和长期生存有负面影响。
