Pandey Durgatosh, Lee Kang-Hoe, Wai Chun-Tao, Wagholikar Gajanan, Tan Kai-Chah
Hepatobiliary Surgery and Liver Transplantation, Asian Centre for Liver Diseases and Transplantation, Singapore, Singapore.
Ann Surg Oncol. 2007 Oct;14(10):2817-23. doi: 10.1245/s10434-007-9518-1. Epub 2007 Aug 10.
Surgical resection is the standard treatment for hepatocellular carcinoma (HCC). However, the role of surgery in treatment of large tumors (10 cm or more) is controversial. We have analyzed, in a single centre, the long-term outcome associated with surgical resection in patients with such large tumors.
We retrospectively investigated 166 patients who had undergone surgical resection between July 1995 and December 2006 because of large (10 cm or more) HCC. Survival analysis was done using the Kaplan-Meier method. Prognostic factors were evaluated using univariate and multivariate analyses.
Of the 166 patients evaluated, 80% were associated with viral hepatitis and 48.2% had cirrhosis. The majority of patients underwent a major hepatectomy (48.2% had four or more segments resected and 9% had additional organ resection). The postoperative mortality was 3%. The median survival in our study was 20 months, with an actuarial 5-year and 10-year overall survival of 28.6% and 25.6%, respectively. Of these patients, 60% had additional treatment in the form of transarterial chemoembolization, radiofrequency ablation or both. On multivariate analysis, vascular invasion (P < 0.001), cirrhosis (P = 0.028), and satellite lesions/multicentricity (P = 0.006) were significant prognostic factors influencing survival. The patients who had none of these three risk factors had 5-year and 10-year overall survivals of 57.7% each, compared with 22.5% and 19.3%, respectively, for those with at least one risk factor (P < 0.001).
Surgical resection for those with large HCC can be safely performed with a reasonable long-term survival. For tumors with poor prognostic factors, there is a pressing need for effective adjuvant therapy.
手术切除是肝细胞癌（HCC）的标准治疗方法。然而，手术在治疗大肿瘤（10厘米或更大）中的作用存在争议。我们在单一中心分析了手术切除与此类大肿瘤患者长期预后的相关性。
我们回顾性研究了1995年7月至2006年12月期间因大（10厘米或更大）HCC接受手术切除的166例患者。采用Kaplan-Meier法进行生存分析。使用单因素和多因素分析评估预后因素。
在评估的166例患者中，80%与病毒性肝炎相关，48.2%有肝硬化。大多数患者接受了大肝切除术（48.2%切除了四个或更多肝段，9%进行了额外器官切除）。术后死亡率为3%。我们研究中的中位生存期为20个月，5年和10年总生存率分别为28.6%和25.6%。这些患者中，60%接受了经动脉化疗栓塞、射频消融或两者结合的额外治疗。多因素分析显示，血管侵犯（P<0.001）、肝硬化（P=0.028）和卫星灶/多中心性（P=0.006）是影响生存的重要预后因素。没有这三个危险因素的患者5年和10年总生存率均为57.7%，而至少有一个危险因素的患者分别为22.5%和19.3%（P<0.001）。
对于大肝癌患者，手术切除可以安全进行，并具有合理的长期生存率。对于预后因素较差的肿瘤，迫切需要有效的辅助治疗。
