巨大肝细胞癌（直径≥10cm）行肝切除术的疗效。
Outcomes of hepatic resection for huge hepatocellular carcinoma (≥ 10 cm in diameter).
机构信息
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
出版信息
J Surg Oncol. 2011 Sep 1;104(3):292-8. doi: 10.1002/jso.21931. Epub 2011 Apr 4.
BACKGROUND
The object of the current study was to review the outcomes of hepatic resection for hepatocellular carcinoma (HCC) ≥ 10 cm.
METHODS
Between 1995 and 2007, fifty-three patients with HCC ≥ 10 cm underwent hepatic resection, and clinical data were compared to those of patients with non-surgical treatment (n = 12). Surgical results for HCC ≥ 10 cm were compared to those of patients with HCC < 10 cm (n = 412). The independent poor prognostic factors of the patients with HCC ≥ 10 cm were identified.
RESULTS
Overall survival was significantly better in patients with hepatic resection for HCC ≥ 10 cm than in those with non-surgical treatment (P < 0.01). Survival rates of patients with hepatic resection for HCC ≥ 10 cm were 35% at 5 years. Morbidity and mortality rate were statistically equal. The independent poor prognostic factors of patients with hepatic resection for HCC ≥ 10 cm were revealed: T4 status, macroscopic tumor thrombus in portal vein (VP+), and the use of intra-operative transfusion.
CONCLUSION
Hepatic resections for HCC ≥ 10 cm are safe and efficacious. Minimizing intra-operative blood loss and the establishment of an effective systemic treatment for patients with HCC ≥ 10 cm in T4 appear to be critical.
背景
本研究旨在回顾≥ 10cm 肝细胞癌（HCC）行肝切除术的治疗效果。
方法
1995 年至 2007 年间，53 例 HCC≥10cm 的患者接受了肝切除术，与未接受手术治疗的患者（n=12）进行了临床数据比较。将 HCC≥10cm 的手术结果与 HCC<10cm 的患者（n=412）进行了比较。确定了 HCC≥10cm 患者的独立不良预后因素。
结果
与未接受手术治疗的患者相比，HCC≥10cm 患者行肝切除术的总体生存率明显提高（P<0.01）。HCC≥10cm 患者行肝切除术的 5 年生存率为 35%。手术的发病率和死亡率统计学上相等。HCC≥10cm 患者行肝切除术的独立不良预后因素为：T4 期、门静脉主干癌栓（VP+）和术中输血。
结论
对于 HCC≥10cm 的患者，肝切除术是安全有效的。对于 T4 期 HCC≥10cm 的患者，减少术中出血和建立有效的全身治疗方法似乎至关重要。
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