Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 28 Yungun-dong, Chongno-gu, Seoul 110-744, Korea.
Dig Dis Sci. 2012 Mar;57(3):813-9. doi: 10.1007/s10620-011-1995-1. Epub 2011 Dec 7.
The clinical features and prognosis of hepatocellular carcinoma (HCC) with peritoneal metastasis have not been fully evaluated.
This study aimed to investigate the risk factors, clinical features, and prognosis of HCC with peritoneal metastasis.
Patients who were diagnosed as HCC with peritoneal metastasis and the same number of randomly selected, risk factor-matched HCC controls without peritoneal metastasis were included. The risk factors and overall survival were compared between peritoneal metastasis-positive and -negative groups after adjustment of other variables.
HCC rupture was an independent risk factor for peritoneal metastasis in HCC patients (P = 0.008). When the risk factors (age, sex, Child-Pugh score, and intrahepatic tumor stage) were matched, peritoneal metastasis failed to independently affect overall survival (P = 0.511). In the peritoneal metastasis-positive group, advanced Child-Pugh class [hazard ratio (HR), 1.99; 95% confidence interval (CI), 1.07-3.72; P = 0.030] and progressive intrahepatic HCC status (HR, 19.04; 95% CI, 2.55-142.13; P = 0.004) were independent risk factors for early death. Complications such as ileus, bleeding, and hydronephrosis due to rectovesical mass were reported in 1.5-7.4% in the peritoneal metastasis-positive group.
Peritoneal metastasis was not found to be an independent prognostic factor of HCC, and among HCC patients with peritoneal metastasis, those with advanced Child-Pugh class and with uncontrolled intrahepatic HCC showed poor survival. Therefore, the maintenance of favorable hepatic function and control of intrahepatic HCC should still be emphasized in HCC patients with peritoneal metastasis.
肝细胞癌（HCC）合并腹膜转移的临床特征和预后尚未得到充分评估。
本研究旨在探讨 HCC 合并腹膜转移的危险因素、临床特征和预后。
纳入诊断为 HCC 合并腹膜转移的患者和随机选择的、具有相同数量且无腹膜转移的危险因素匹配的 HCC 对照患者。调整其他变量后，比较腹膜转移阳性和阴性组的危险因素和总生存期。
HCC 破裂是 HCC 患者发生腹膜转移的独立危险因素（P = 0.008）。当匹配危险因素（年龄、性别、Child-Pugh 评分和肝内肿瘤分期）时，腹膜转移不能独立影响总生存期（P = 0.511）。在腹膜转移阳性组中，较高的 Child-Pugh 分级[风险比（HR），1.99；95%置信区间（CI），1.07-3.72；P = 0.030]和进展性肝内 HCC 状态（HR，19.04；95%CI，2.55-142.13；P = 0.004）是早期死亡的独立危险因素。腹膜转移阳性组报告了 1.5%-7.4%的肠梗阻、出血和肾盂积水等并发症。
腹膜转移不是 HCC 的独立预后因素，在合并腹膜转移的 HCC 患者中，Child-Pugh 分级较高且肝内 HCC 无法控制的患者生存较差。因此，在合并腹膜转移的 HCC 患者中，仍应强调维持良好的肝功能和控制肝内 HCC。
