Kawamura Masafumi, Nakajima Jun, Matsuguma Haruhisa, Horio Hirotoshi, Miyoshi Shinichiro, Nakagawa Ken, Fujisawa Takehiko, Kobayashi Koichi
Division of General Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan.
Eur J Cardiothorac Surg. 2008 Jul;34(1):196-9. doi: 10.1016/j.ejcts.2008.03.056. Epub 2008 May 1.
Although favourable prognosis following aggressive treatment of extrahepatic metastases from hepatocellular carcinoma (HCC) has been reported, surgical outcomes for pulmonary metastases are unclear.
Sixty-one patients (2.6%) of 2297 registered with the Metastatic Lung Tumor Study Group of Japan between 1990 and 2006, who underwent surgery for pulmonary metastases from HCC, were retrospectively reviewed from the registry.
The overall 5-year survival rate was 32.2%. The prognosis was significantly better for < or =2 lesions than for > or =3 lesions (p=0.046), for < or =3 lesions than for > or =4 lesions (p=0.0070), and for < or =4 lesions than for > or =5 lesions (p=0.029). No other factors that influence outcomes were identified. A stepwise regression analysis showed three or less pulmonary metastases to be an independent factor for better prognosis (p=0.048).
With careful patient selection, comparatively good outcomes can be expected following surgical resection of pulmonary HCC metastases. Among them, patients with multiple metastases, if number of metastases is small such as four or less, can be expected to survive long after surgery.
尽管有报道称积极治疗肝细胞癌（HCC）肝外转移后预后良好，但肺转移的手术效果尚不清楚。
对1990年至2006年间在日本转移性肺肿瘤研究组登记的2297例患者中的61例（2.6%）进行回顾性研究，这些患者因HCC肺转移接受了手术。
总体5年生存率为32.2%。≤2个病灶的患者预后明显好于≥3个病灶的患者（p=0.046），≤3个病灶的患者预后明显好于≥4个病灶的患者（p=0.0070），≤4个病灶的患者预后明显好于≥5个病灶的患者（p=0.029）。未发现其他影响预后的因素。逐步回归分析显示，三个或更少的肺转移是预后较好的独立因素（p=0.048）。
通过仔细选择患者，HCC肺转移手术切除后有望获得相对较好的疗效。其中，多发转移患者，如果转移灶数量较少，如四个或更少，术后有望长期存活。
