Furuta T, Kanematsu T, Matsumata T, Shirabe K, Yamagata M, Utsunomiya T, Sugimachi K
Department of Surgery II, Kyushu University, Faculty of Medicine, Fukuoka, Japan.
Hepatogastroenterology. 1990 Oct;37(5):494-7.
Curative resections were performed in 200 patients with primary hepatocellular carcinoma (HCC) during the period from 1971 to 1988, at Kyushu University Hospital. Patients seen before 1982 numbered 73 (group I), and the remaining 127 underwent hepatic resection after 1983 (group II). Thirty-nine (53.4%) of the 73 patients in group I had a recurrence during the follow-up period, as did 61 (48.0%) in group II. HCC resections done after 1983 (group II) were associated with (1) a low incidence of operative deaths (I 15.1% vs. II 2.4%) and hospital deaths (I 30.1% vs. II 5.5%), (2) relatively well-preserved hepatocellular function (indocyanine green test, I 24.5 +/- 12.6% vs. II 17.4 +/- 9.2%), (3) a low incidence of histologically verified concomitant cirrhosis (I 87.7% vs. II 68.5%) (4), and smaller HCC nodules (I 6.4 +/- 4.4 cm vs. II 4.1 +/- 3.1 cm). The survival rates of patients seen after 1983 were significantly better than those of patients resected prior to 1982. With respect of the recurrence-free rates achieved by curative hepatic resection, there was no statistically significant difference to be seen between the two groups. In the case of patients submitted of lipiodolization treatment for a recurrent HCC, the survival rates were better than in patients on systemic chemotherapy. Since lipiodolization prolongs survival time after a recurrence of HCC, this form of treatment should be given due consideration.
1971年至1988年期间，在九州大学医院对200例原发性肝细胞癌（HCC）患者进行了根治性切除术。1982年前就诊的患者有73例（第一组），其余127例在1983年后接受了肝切除术（第二组）。第一组的73例患者中有39例（53.4%）在随访期间复发，第二组的127例中有61例（48.0%）复发。1983年后进行的HCC切除术（第二组）具有以下特点：（1）手术死亡率（第一组15.1% vs. 第二组2.4%）和住院死亡率（第一组30.1% vs. 第二组5.5%）较低；（2）肝细胞功能相对保存较好（吲哚菁绿试验，第一组24.5±12.6% vs. 第二组17.4±9.2%）；（3）组织学证实的合并肝硬化发生率较低（第一组87.7% vs. 第二组68.5%）；（4）HCC结节较小（第一组6.4±4.4 cm vs. 第二组4.1±3.1 cm）。1983年后就诊患者的生存率明显高于1982年前接受手术的患者。就根治性肝切除术后的无复发生存率而言，两组之间没有统计学上的显著差异。对于复发性HCC接受碘油栓塞治疗的患者，其生存率高于接受全身化疗的患者。由于碘油栓塞可延长HCC复发后的生存时间，应适当考虑这种治疗方式。
