Department of Hepato-Pancreato-Biliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong Province, China.
World J Surg. 2010 Oct;34(10):2434-41. doi: 10.1007/s00268-010-0664-4.
This study was designed to evaluate the prognostic factors and outcome of 438 Chinese patients with hepatocellular carcinoma who underwent partial hepatectomy in a single center.
Clinicopathological data of 438 patients with hepatocellular carcinoma who underwent partial hepatectomy at the author's hospital between 1991 and 2004 were reviewed retrospectively. The Kaplan-Meier method was adopted for evaluating survival. Prognostic factors were assessed by Cox proportional hazard model and logistic regression model.
The perioperative (30 days) mortality and morbidity were 7.5% (33/438) and 21.7% (95/438), respectively. The operative mortality decreased significantly from 10.6% (23/218) in 1991-2001 to 4.5% (10/220) in 2002-2004 (P = 0.019). Postoperative overall survival rates at 1 year, 3 years, and 5 years were 72.2%, 53.5%, and 43.3%, respectively. Cox multivariate analysis indicated that Child-Pugh score, tumor size, capsular invasion, tumor stage, vascular invasion, and resection margin were independent prognostic factors for overall survival (P < 0.05). Also, 254 cases had tumor recurrence after operation and 87 cases of them were reoperated. Logistic multivariate analysis showed that tumor size, capsular invasion, vascular invasion, lymph node metastasis, extrahepatic metastasis, and resection margin were independent risk factors of tumor recurrence (P < 0.05).
Tumor size, capsular invasion, vascular invasion, and resection margin were the main factors that may impact the overall survival and tumor recurrence. Because resection margin was the only factor that relates to the surgery, enough resection margin (>2 cm) should be obtained whenever possible.
本研究旨在评估 438 例在中国某单一中心接受肝部分切除术的肝细胞癌患者的预后因素和结局。
回顾性分析 1991 年至 2004 年期间在作者医院接受肝部分切除术的 438 例肝细胞癌患者的临床病理资料。采用 Kaplan-Meier 法评估生存情况。采用Cox 比例风险模型和 logistic 回归模型评估预后因素。
围手术期（30 天）死亡率和发病率分别为 7.5%（33/438）和 21.7%（95/438）。手术死亡率从 1991-2001 年的 10.6%（23/218）显著下降至 2002-2004 年的 4.5%（10/220）（P = 0.019）。术后 1 年、3 年和 5 年的总生存率分别为 72.2%、53.5%和 43.3%。Cox 多因素分析表明，Child-Pugh 评分、肿瘤大小、包膜侵犯、肿瘤分期、血管侵犯和切缘是总生存的独立预后因素（P < 0.05）。术后 254 例患者肿瘤复发，其中 87 例再次手术。Logistic 多因素分析表明，肿瘤大小、包膜侵犯、血管侵犯、淋巴结转移、肝外转移和切缘是肿瘤复发的独立危险因素（P < 0.05）。
肿瘤大小、包膜侵犯、血管侵犯和切缘是影响总生存和肿瘤复发的主要因素。由于切缘是唯一与手术相关的因素，因此应尽可能获得足够的切缘（>2 cm）。
