Department of Surgery, Yonsei University Health System, Seoul 120-752, Korea.
Am J Surg. 2009 Nov;198(5):693-701. doi: 10.1016/j.amjsurg.2008.09.019. Epub 2009 Mar 6.
The purpose of this study was to investigate the surgical outcomes in patients with huge (>or=10 cm) hepatocellular carcinoma (HCC).
Clinicopathological features and surgical outcomes of 50 patients with huge HCC who underwent curative resection (group A) were compared with 447 patients with smaller tumors (group B). In group A, we investigated prognostic factors.
Group A patients had a higher incidence of alpha-fetoprotein at more than 1,000 IU/mL, microscopic vascular invasion, and advanced stage tumors. The disease-free survival of group A was significantly worse than group B. The rates of initial extrahepatic recurrence and early recurrence were higher in group A. The 5 year-overall survival of group A was 40.2%, significantly lower than that of group B (65.9% at 5 years). In group A, multivariate analysis revealed that the presence of single nodular type tumors was the only good prognostic factor for survival.
Huge HCCs exhibit a more aggressive clinical behavior and worse survival. However, because the outcome of surgical treatment is far better than that of nonsurgical treatment, resection should be actively considered for patients with huge HCC. A single nodular type tumor is the best candidate for surgical resection.
本研究旨在探讨巨大（>或=10 cm）肝细胞癌（HCC）患者的手术治疗效果。
比较 50 例接受根治性切除术的巨大 HCC 患者（A 组）与 447 例较小肿瘤患者（B 组）的临床病理特征和手术结果。在 A 组中，我们探讨了预后因素。
A 组患者甲胎蛋白（AFP）水平>1000 IU/mL、存在微血管侵犯和肿瘤分期较晚的比例较高。A 组患者无瘤生存率明显低于 B 组。A 组患者初始肝外复发率和早期复发率较高。A 组患者 5 年总生存率为 40.2%，明显低于 B 组（5 年生存率为 65.9%）。多因素分析显示，单发结节型肿瘤是影响生存的唯一良好预后因素。
巨大 HCC 具有侵袭性更强的临床行为和更差的生存预后。然而，由于手术治疗的效果远优于非手术治疗，对于巨大 HCC 患者应积极考虑手术切除。单发结节型肿瘤是手术切除的最佳适应证。
