Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
J Gastroenterol Hepatol. 2011 Nov;26(11):1646-51. doi: 10.1111/j.1440-1746.2011.06780.x.
Despite improvements of treatment in hepatocellular carcinoma (HCC), the recurrence rate after curative hepatic resection still remains remarkably high. An immediate recurrence of HCC after surgery is frustrating. We tried to clarify risks of immediate postoperative recurrence of HCC; that is, within 4 months after curative hepatic resection.
A total of 167 patients with HCC underwent hepatic resection; 60 had immediate postoperative recurrences (IPR group), and 107 had disease-free survival for more than 5 years (DFS group). Variables were compared between the two groups.
Univariate analysis showed the following variables were significant risk factors for immediate postoperative recurrence of HCC: male sex, elevated serum aspartate aminotransferase level, greater amount of blood loss, longer operation time, worse tumor differentiation, higher tumor node metastasis stage, and presence of any of the following: intrahepatic metastasis, tumor-rupture, portal venous invasion, or microvascular invasion. In multivariate analysis, only portal venous invasion was a significant risk factor (odds ratio=3.2, P=0.03, standard error=0.5, Logistic regression analysis).
Portal venous invasion may be the most significant risk factor for immediate postoperative recurrence of HCC. However, accurate assessment of this risk factor may require histological examination, limiting its utility as a preoperative predictor. Further research is necessary to definitively identify preoperative predictors.
尽管肝细胞癌（HCC）的治疗有所改善，但根治性肝切除术后的复发率仍然很高。手术后 HCC 的即刻复发令人沮丧。我们试图阐明 HCC 即刻术后复发的风险；即在根治性肝切除术后 4 个月内。
共有 167 例 HCC 患者接受了肝切除术；60 例发生即刻术后复发（IPR 组），107 例无病生存 5 年以上（DFS 组）。对两组间的变量进行比较。
单因素分析显示，以下变量是 HCC 即刻术后复发的显著危险因素：男性、血清天门冬氨酸转氨酶水平升高、出血量较多、手术时间较长、肿瘤分化较差、肿瘤淋巴结转移分期较高、存在以下任何一种情况：肝内转移、肿瘤破裂、门静脉侵犯或微血管侵犯。多因素分析显示，只有门静脉侵犯是显著的危险因素（优势比=3.2，P=0.03，标准误=0.5，Logistic 回归分析）。
门静脉侵犯可能是 HCC 即刻术后复发的最重要危险因素。然而，这种危险因素的准确评估可能需要组织学检查，这限制了其作为术前预测因素的实用性。需要进一步研究以明确术前预测因素。
