Department of Gastroenterological Surgery, Transplant, and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama-shi, 700-8558, Okayama, Japan.
World J Surg. 2011 Jan;35(1):170-7. doi: 10.1007/s00268-010-0794-8.
The aim of this study was to evaluate the prognostic factors for intrahepatic recurrence of hepatocellular carcinoma (HCC) after curative resection.
Of 297 patients with HCC who underwent curative resection between 1998 and 2007, 145 had intrahepatic recurrence, and 125 of these were enrolled in this study. We analyzed the relationships between overall survival after HCC recurrence and 20 variables at initial hepatectomy and recurrence.
Recurrent HCC was treated by repeat hepatectomy (Re-Hr, n = 29), radiofrequency ablation (RFA, n = 58), or transarterial chemoembolization (TAE, n = 38). Complete tumor control (CTC) by Re-He and RFA was selected for 70% of patients. RFA-treated patients had more tumors, smaller tumors, and poorer liver function at recurrence than the Re-Hr group. The overall 1-, 3-, and 5-year post-recurrence survival rates (SR) were 93.1, 66.8, 58.1%; 94.7, 75.1, 48.3%; and 80.1, 22.5, 0%, respectively, in the Re-Hr, RFA, and TAE groups. The SR was better for Re-Hr and RFA than for TAE (p < 0.0001). Outcomes were similar in Re-Hr and RFA, regardless of recurrent tumor size. Multivariate analysis identified Child-Pugh grade B, AFP ≥100 ng/ml at recurrence, recurrent tumor size ≥3 cm, tumor number ≥3, and CTC as significant prognostic factors for overall post-recurrence survival. A scoring system using 1 point for each patient-background factor provided a well-categorized predictive model. The overall 3-/5-year post-recurrence SRs were 83.1/59.3%, 64.1/41.9%, 42.0/18.0%, and 13.6/0% at risk number (R) R0, R1, R2, and R3/4, respectively (p < 0.05).
Significant prognostic factors for intrahepatic recurrent HCC are poor hepatic reserve, AFP, recurrent tumor size and number, and CTC. Selection of treatment modality for intrahepatic recurrence requires the clinician to be mindful of the predictive factors and to control tumors aggressively by adequate treatment, selected by balancing various conditions.
本研究旨在评估肝癌（HCC）根治性切除术后肝内复发的预后因素。
1998 年至 2007 年间，297 例 HCC 患者接受根治性切除术，其中 145 例发生肝内复发，125 例纳入本研究。我们分析了初始肝切除和复发时 20 个变量与 HCC 复发后总生存率之间的关系。
复发性 HCC 采用再次肝切除术（Re-Hr，n=29）、射频消融术（RFA，n=58）或经动脉化疗栓塞术（TAE，n=38）治疗。Re-He 和 RFA 治疗的患者中，70%达到完全肿瘤控制（CTC）。RFA 治疗组患者在复发时具有更多的肿瘤、更小的肿瘤和更差的肝功能。Re-Hr、RFA 和 TAE 组患者的总复发后 1、3 和 5 年生存率（SR）分别为 93.1%、66.8%和 58.1%；94.7%、75.1%和 48.3%；80.1%、22.5%和 0%。Re-Hr 和 RFA 的 SR 优于 TAE（p＜0.0001）。无论复发性肿瘤大小如何，Re-Hr 和 RFA 的结果均相似。多因素分析显示，Child-Pugh 分级 B、复发时 AFP≥100ng/ml、复发性肿瘤大小≥3cm、肿瘤数量≥3 个和 CTC 是总体复发后生存的显著预后因素。使用每位患者背景因素各加 1 分的评分系统，提供了一个良好分类的预测模型。复发性肿瘤 R0、R1、R2 和 R3/4 风险数（R）分别为 13.6/0%、64.1/41.9%、42.0/18.0%和 83.1/59.3%（p＜0.05）。
肝癌肝内复发的显著预后因素为肝脏储备功能差、AFP、复发性肿瘤大小和数量以及 CTC。肝内复发治疗方式的选择需要临床医生注意预测因素，并通过适当的治疗积极控制肿瘤，根据各种情况的平衡选择治疗方法。
