Lee S G, Hwang S, Jung J P, Lee Y J, Kim K H, Ahn C S
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul 138-736, Korea.
Br J Surg. 2007 Mar;94(3):320-6. doi: 10.1002/bjs.5622.
Tumour recurrence is common after hepatic resection of hepatocellular carcinomas (HCCs) greater than 10 cm in diameter. This study evaluated the outcome of patients with huge HCC after primary resection and treatment of recurrent lesions.
A retrospective review was undertaken of clinical data for 100 patients with huge HCC who underwent liver resection.
Mean(s.d.) tumour diameter was 13.3(3.0) cm; 80 per cent were single lesions. Systematic and non-systematic resections were performed in 80 and 20 per cent of patients respectively, with R0 resection achieved in 86 per cent. Overall 1-, 3- and 5-year disease-free survival rates were 43, 26 and 20 per cent respectively. Risk factors for HCC recurrence were resection margin less than 1 cm and macrovascular invasion. Extensive tumour necrosis of 90 per cent or more after preoperative transarterial chemoembolization was not a prognostic factor. Some 85 per cent of patients with recurrence received various treatments, and these patients had a longer post-recurrence survival than those who were not treated. Overall 1-, 3- and 5-year survival rates were 66, 44 and 31 per cent respectively.
In patients with huge HCC, hepatic resection combined with active treatment for recurrence resulted in longer-term survival. Frequent protocol-based follow-up appears to be beneficial for the early detection and timely treatment of recurrence.
直径大于10厘米的肝细胞癌（HCC）肝切除术后肿瘤复发很常见。本研究评估了巨大HCC患者初次切除及复发病灶治疗后的结局。
对100例行肝切除的巨大HCC患者的临床资料进行回顾性分析。
肿瘤平均（标准差）直径为13.3（3.0）厘米；80%为单发病灶。分别有80%和20%的患者接受了系统性和非系统性切除，R0切除率为86%。总体1年、3年和5年无病生存率分别为43%、26%和20%。HCC复发的危险因素为切缘小于1厘米和大血管侵犯。术前经动脉化疗栓塞后肿瘤广泛坏死达90%或以上并非预后因素。约85%的复发患者接受了各种治疗，这些患者复发后的生存期长于未接受治疗的患者。总体1年、3年和5年生存率分别为66%、44%和31%。
对于巨大HCC患者，肝切除联合积极的复发治疗可延长生存期。基于方案的频繁随访似乎有利于复发的早期检测和及时治疗。
