Bhaijee F, Krige J E J, Locketz M L, Kew M C
Surgical Gastroenterology Unit, Groote Schuur Hospital.
S Afr J Surg. 2011 Apr;49(2):68-74.
We describe the clinicopathologic features and outcome of South African patients who have undergone hepatic resection for hepatocellular carcinoma (HCC) arising in a non-cirrhotic liver.
We utilised the prospective liver resection database in the Surgical Gastroenterology Unit at Groote Schuur Hospital, Cape Town, to identify all patients who underwent surgery for HCC with non-cirrhotic liver parenchyma between 1990 and 2008.
Twenty-two patients (10 men, 12 women, 3 black, 19 white, median age 47 years, range 21-79 years) underwent surgery for non-cirrhotic HCC. Sixteen patients had non-fibrolamellar HCC (Group 1); 6 patients had fibrolamellar HCC (Group 2). Group 1 had a median age of 55 years, and 6 (38%) were men; group 2 had a median age of 21 years, and 5 (83%) were men. Most patients had a solitary tumour at diagnosis; median largest tumour diameters in Groups 1 and 2 were 10 cm (range 4-21) and 12 cm (range 4-17), respectively. Patients in Group 1 underwent extended right hepatectomy (N=3), right hepatectomy (N=3), left hepatectomy (N=3), partial hepatectomy (N=7), cholecystectomy (N=6), and appendicectomy (N=1). Patients in Group 2 underwent extended right hepatectomy (N=1), right hepatectomy (N=1), left hepatectomy (N=2), segmentectomy (N=2), and portal lymphadenectomy (N=3). Recurrence rates in Groups 1, 2, and overall were 81%, 100% and 86%, respectively. Median overall survival was 46 months, with 1-, 3-, and 5-year survival rates of 95%, 59% and 45%, respectively. In Group 1, median survival was 39 months, with 1-, 3-, and 5-year survival rates of 100%, 56% and 38% respectively. In Group 2, median survival was 61 months, with 1-, 3-, and 5-year survival rates of 83%, 67% and 67%, respectively.
Despite aggressive surgical resection, HCC arising in normal liver parenchyma has a high recurrence rate and an ultimately poor outcome. This finding is similar to both the recent international experience of non-cirrhotic HCC and local experience of fibrolamellar HCC.
我们描述了南非非肝硬化性肝内肝细胞癌（HCC）患者接受肝切除术后的临床病理特征及预后情况。
我们利用开普敦格罗特舒尔医院外科胃肠病科的前瞻性肝切除数据库，确定1990年至2008年间所有因非肝硬化性肝实质的HCC接受手术的患者。
22例患者（10例男性，12例女性，3例黑人，19例白人，中位年龄47岁，范围21 - 79岁）接受了非肝硬化性HCC手术。16例患者为非纤维板层型HCC（第1组）；6例患者为纤维板层型HCC（第2组）。第1组中位年龄55岁，6例（38%）为男性；第2组中位年龄21岁，5例（83%）为男性。大多数患者诊断时为单发肿瘤；第1组和第2组最大肿瘤直径中位数分别为10 cm（范围4 - 21）和12 cm（范围4 - 17）。第1组患者接受了扩大右肝切除术（N = 3）、右肝切除术（N = 3）、左肝切除术（N = 3）、部分肝切除术（N = 7）、胆囊切除术（N = 6）和阑尾切除术（N = 1）。第2组患者接受了扩大右肝切除术（N = 1）、右肝切除术（N = 1）、左肝切除术（N = 2）、节段切除术（N = 2）和门静脉淋巴结清扫术（N = 3）。第1组、第2组及总体复发率分别为81%、100%和86%。中位总生存期为46个月，1年、3年和5年生存率分别为95%、59%和45%。在第1组中，中位生存期为39个月，1年、3年和5年生存率分别为100%、56%和38%。在第2组中，中位生存期为61个月，1年、3年和5年生存率分别为83%、67%和67%。
尽管进行了积极的手术切除，但正常肝实质内发生的HCC复发率高，最终预后较差。这一发现与近期非肝硬化性HCC的国际经验及纤维板层型HCC的本地经验相似。
