Kikuchi Luciana O O, Paranaguá-Vezozzo Denise C, Chagas Aline L, Mello Evandro S, Alves Venancio A F, Farias Alberto Q, Pietrobon Ricardo, Carrilho Flair J
Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil.
J Clin Gastroenterol. 2009 Feb;43(2):191-5. doi: 10.1097/MCG.0b013e31817ff199.
The aims of this study were to analyze the overall survival of patients with cirrhosis and small hepatocellular carcinoma (HCC) and identify independent pretreatment predictors of survival in Brazil.
Between 1998 and 2003, 74 patients with cirrhosis and small HCC were evaluated. Predictors of survival were identified using the Kaplan-Meier survival curves and the Cox model.
The overall survival rates were 80%, 41%, and 17% at 12, 36, and 60 months, respectively. The mean length of follow-up after HCC diagnosis was 23 months (median 22 mo, range: 1 to 86 mo) for the entire group. Univariate analysis showed that model for endstage liver disease (MELD) score (P=0.016), Child-Pugh classification (P=0.007), alpha-fetoprotein level (P=0.006), number of nodules (P=0.041), tumor diameter (P=0.009), and vascular invasion (P<0.0001) were significant predictors of survival. Cox regression analysis identified vascular invasion (relative risk=14.60, confidence interval 95%=3.3-64.56, P<0.001) and tumor size >20 mm (relative risk=2.14, confidence interval 95%=1.07-4.2, P=0.030) as independent predictors of decreased survival. Treatment of HCC was related to increased overall survival.
Identification of HCC smaller than 20 mm is associated with longer survival. Presence of vascular invasion, even in small tumors, maybe associated with poor prognosis. Treatment of small tumors of up to 20 mm diameter is related to increased survival.
本研究旨在分析肝硬化合并小肝细胞癌（HCC）患者的总生存率，并确定巴西患者生存的独立预处理预测因素。
1998年至2003年期间，对74例肝硬化合并小HCC患者进行了评估。使用Kaplan-Meier生存曲线和Cox模型确定生存预测因素。
12个月、36个月和60个月时的总生存率分别为80%、41%和17%。整个组HCC诊断后的平均随访时间为23个月（中位数22个月，范围：1至86个月）。单因素分析显示，终末期肝病模型（MELD）评分（P=0.016）、Child-Pugh分级（P=0.007）、甲胎蛋白水平（P=0.006）、结节数量（P=0.041）、肿瘤直径（P=0.009）和血管侵犯（P<0.0001）是生存的重要预测因素。Cox回归分析确定血管侵犯（相对风险=14.60，95%置信区间=3.3-64.56，P<0.001）和肿瘤大小>20mm（相对风险=2.14，95%置信区间=1.07-4.2，P=0.030）是生存降低的独立预测因素。HCC的治疗与总生存率提高相关。
小于20mm的HCC的识别与更长的生存期相关。血管侵犯的存在，即使在小肿瘤中，也可能与预后不良相关。直径达20mm的小肿瘤的治疗与生存率提高相关。
