Hosaka Tetsuya, Ikeda Kenji, Kobayashi Masahiro, Hirakawa Miharu, Kawamura Yusuke, Yatsuji Hiromi, Sezaki Hitomi, Akuta Norio, Suzuki Fumitaka, Suzuki Yoshiyuki, Saitoh Satoshi, Arase Yasuji, Kumada Hiromitsu
Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
Liver Int. 2009 May;29(5):736-42. doi: 10.1111/j.1478-3231.2008.01901.x. Epub 2008 Oct 27.
The tumour recurrence rate after resection is still high even in patients with small hepatocellular carcinoma (HCC). The advanced patterns of recurrence occasionally occur after resection. In this study, we analysed the clinical and histological characteristics of small HCC and evaluated the predictive factors of advanced tumour recurrence.
One hundred and sixty-five patients underwent resection of small HCC measuring 3 cm or less in greatest dimension. Patterns of tumour recurrences were classified into advanced recurrence and minor recurrence based on size, number, vascular invasion and extrahepatic metastasis of recurrent tumour. We created a simple index to closely evaluate the malignant potential of small HCC, named alpha-foetoprotein-size ratio index (ASRI).
Overall tumour recurrence was significantly associated with tumour multiplicity (P<0.001) and ASRI (P=0.001). Tumour multiplicity, ASRI and tumour differentiation were independent and significant predictive factors of advanced recurrences. The overall survival rates were lower in the advanced recurrence group than the minor recurrence or the no recurrence group.
Patients with advanced recurrences have a poor prognosis, although they have undergone curative resection of small HCC. On the other hand, patients with minor recurrences have a relatively good prognosis. ASRI was a useful index to predict advanced recurrence after curative resection of small HCC. The therapeutic management to prevent advanced recurrences is needed.
即使是小肝细胞癌（HCC）患者，切除术后的肿瘤复发率仍然很高。切除术后偶尔会出现晚期复发模式。在本研究中，我们分析了小肝癌的临床和组织学特征，并评估了晚期肿瘤复发的预测因素。
165例患者接受了最大直径3cm或更小的小肝癌切除术。根据复发肿瘤的大小、数量、血管侵犯和肝外转移情况，将肿瘤复发模式分为晚期复发和微小复发。我们创建了一个简单的指标来密切评估小肝癌的恶性潜能，称为甲胎蛋白-大小比指数（ASRI）。
总体肿瘤复发与肿瘤多灶性（P<0.001）和ASRI（P=0.001）显著相关。肿瘤多灶性、ASRI和肿瘤分化是晚期复发的独立且显著的预测因素。晚期复发组的总生存率低于微小复发组或无复发组。
尽管小肝癌患者接受了根治性切除，但晚期复发患者的预后较差。另一方面，微小复发患者的预后相对较好。ASRI是预测小肝癌根治性切除术后晚期复发的有用指标。需要采取治疗措施预防晚期复发。
