肝切除术治疗大肝癌的复发和生存相关因素：多中心分析。

Factors associated with recurrence and survival following hepatectomy for large hepatocellular carcinoma: a multicenter analysis.

机构信息

Division of Surgical Oncology, Department of Surgery, James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky 40202, USA.

出版信息

J Surg Oncol. 2010 Feb 1;101(2):105-10. doi: 10.1002/jso.21461.

DOI:10.1002/jso.21461

PMID:20035538

Abstract

BACKGROUND

Optimal management of large (>5 cm) hepatocellular carcinoma (HCC) remains controversial. We sought to determine the factors associated with recurrence and survival for patients with large HCC following hepatectomy.

METHODS

An analysis of a combined prospective database from two tertiary care centers was performed on consecutive patients who underwent hepatectomy for HCC > 5 cm. Univariate and multivariate analyses were performed to determine factors associated with recurrence, disease-free (DFS) and overall survival (OS).

RESULTS

Seventy-eight patients were identified: 32 (41%) had hepatic fibrosis. Forty-six patients (59%) underwent a major hepatectomy with a morbidity rate of 41% and a mortality rate of 13%. Fibrosis was associated with male gender (P = 0.045), hepatitis C (P = 0.003), higher Child-Pugh (P < 0.0001) and Okuda score (P = 0.002), smaller tumors (6.25 cm vs. 10.5 cm; P < 0.001), positive-margin resection (P = 0.01), and death (P = 0.047). Factors associated with recurrence include tumor multifocality (P = 0.03) and vascular invasion (P = 0.02). Predictors of OS include multifocal tumors (P = 0.05), margin status (P = 0.02), vascular invasion (P = 0.01), and treatment complications (P = 0.004). The median overall DFS and OS were 12 and 20 months, respectively. Fibrosis had no impact on DFS (P = 0.24) or OS (P = 0.20).

CONCLUSIONS

For patients with HCC larger than 5 cm, tumor-related factors predict outcomes and survival.

摘要

背景

对于直径大于 5 厘米的大肝癌（HCC）的最佳治疗方法仍存在争议。本研究旨在探讨接受肝癌切除术的大肝癌患者的复发和生存相关因素。

方法

对来自两家三级医疗机构的前瞻性数据库中的连续患者进行了分析，这些患者因直径大于 5 厘米的 HCC 而行肝切除术。进行单因素和多因素分析，以确定与复发、无病生存（DFS）和总生存（OS）相关的因素。

结果

共确定了 78 例患者：32 例（41%）存在肝纤维化。46 例（59%）接受了大范围肝切除术，发病率为 41%，死亡率为 13%。纤维化与男性（P = 0.045）、丙型肝炎（P = 0.003）、较高的 Child-Pugh 评分（P < 0.0001）和 Okuda 评分（P = 0.002）、肿瘤较小（6.25cm 与 10.5cm；P < 0.001）、切缘阳性（P = 0.01）和死亡（P = 0.047）有关。与复发相关的因素包括肿瘤多灶性（P = 0.03）和血管侵犯（P = 0.02）。OS 的预测因素包括多灶性肿瘤（P = 0.05）、切缘状态（P = 0.02）、血管侵犯（P = 0.01）和治疗并发症（P = 0.004）。中位总 DFS 和 OS 分别为 12 个月和 20 个月。纤维化对 DFS（P = 0.24）或 OS（P = 0.20）无影响。