Kubo Shoji, Tanaka Hiromu, Takemura Shigekazu, Yamamoto Satoshi, Hai Seikan, Ichikawa Tsuyoshi, Kodai Shintaro, Shinkawa Hiroji, Shuto Taichi, Hirohashi Kazuhiro
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
Surg Today. 2007;37(4):285-90. doi: 10.1007/s00595-006-3403-6. Epub 2007 Mar 26.
Interferon therapy suppresses the development of hepatocellular carcinoma (HCC) and tumor recurrence after a resection of HCC in patients with chronic hepatitis C. However, the value of a liver resection and which method is best for the treatment of HCC detected after successful interferon therapy remains to be clarified. The risk factors for tumor recurrence after a liver resection for HCC detected after successful interferon therapy were investigated to determine the appropriate operative method for such HCC.
Risk factors including the clinicopathologic findings and the operative methods for tumor recurrence were evaluated by univariate and multivariate analyses in 24 patients who underwent liver resection for HCC detected after successful interferon therapy (sustained viral response or biochemical response).
According to a univariate analysis, large tumor (> 2 cm, P = 0.0326), multiple tumors (P = 0.0372), nonanatomic resection (P = 0.0103), and positive surgical margin (< 5 mm of a free surgical margin, P = 0.0245) were possible risk factors for short tumor-free survival time after surgery. A multivariate analysis showed that large tumor (P = 0.0407), nonanatomic resection (P = 0.0215), and positive surgical margin (P = 0.0253) were independent risk factors for a short tumor-free survival time after surgery.
An anatomic resection with an appropriate surgical margin (> or = 5 mm of a free surgical margin) is recommended for patients with HCC detected after successful interferon therapy.
干扰素治疗可抑制慢性丙型肝炎患者肝细胞癌(HCC)的发生及HCC切除术后的肿瘤复发。然而,肝切除的价值以及哪种方法最适合治疗干扰素治疗成功后检测出的HCC仍有待阐明。本研究调查了干扰素治疗成功后检测出的HCC患者肝切除术后肿瘤复发的危险因素,以确定此类HCC合适的手术方法。
对24例干扰素治疗成功(持续病毒学应答或生化应答)后检测出HCC并接受肝切除的患者,通过单因素和多因素分析评估包括临床病理特征及肿瘤复发手术方法在内的危险因素。
单因素分析显示,肿瘤较大(>2 cm,P = 0.0326)、肿瘤多发(P = 0.0372)、非解剖性切除(P = 0.0103)及手术切缘阳性(切缘宽度<5 mm,P = 0.0245)可能是术后无瘤生存时间短的危险因素。多因素分析表明,肿瘤较大(P = 0.0407)、非解剖性切除(P = 0.0215)及手术切缘阳性(P = 0.0253)是术后无瘤生存时间短的独立危险因素。
对于干扰素治疗成功后检测出HCC的患者,建议行具有合适手术切缘(切缘宽度≥5 mm)的解剖性切除。