Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Surg Today. 2012 Jun;42(6):526-31. doi: 10.1007/s00595-011-0090-8. Epub 2011 Dec 17.
Pulmonary metastasis is the most common type of extrahepatic recurrence of hepatocellular carcinoma (HCC). The outcome of pulmonary metastasectomy of HCC has not yet been thoroughly investigated. The outcomes of surgical treatment of pulmonary metastases from HCC were reviewed in order to analyze the postoperative survival and the relevant prognostic factors.
This study retrospectively reviewed 20 patients who underwent pulmonary metastasectomy from an HCC between 1990 and 2007 at two institutions. The surgical outcome was evaluated by both the overall survival and cancer-specific survival after pulmonary resection. The association between various clinico-pathological factors and the survival outcome was analyzed.
The overall survival rate after the initial pulmonary metastasectomy was 46.9% at 5 years, and the cancer-specific 5-year survival rate was 63.2%. One patient died of surgery-related events 19 days after the pulmonary resection. The preoperative AFP (alpha-fetoprotein) level was found to be a significant prognostic factor for both overall and cancer-specific survival for patients undergoing pulmonary metastasectomy. Both the overall and cancer-specific survival rates were significantly worse for the patients with AFP ≥ 500 ng/ml in comparison to those with AFP < 500 ng/ml (p < 0.05). No other factors were associated with the survival after pulmonary metastasectomy.
The serum level of AFP might be a valuable predictor for the outcome of pulmonary metastasectomy required for metastasis of HCC.
肺转移是肝细胞癌（HCC）最常见的肝外复发类型。 HCC 肺转移瘤切除术的结果尚未得到彻底研究。回顾性分析了 HCC 肺转移瘤的外科治疗结果，以分析术后生存情况和相关预后因素。
本研究回顾性分析了 1990 年至 2007 年在两个机构接受 HCC 肺转移瘤切除术的 20 例患者。通过肺切除术后的总生存率和癌症特异性生存率评估手术结果。分析了各种临床病理因素与生存结果之间的关系。
初次肺转移瘤切除术后的总生存率为 5 年时为 46.9%，癌症特异性 5 年生存率为 63.2%。1 例患者在肺切除术后 19 天死于手术相关事件。术前 AFP（甲胎蛋白）水平是接受肺转移瘤切除术的患者总生存率和癌症特异性生存率的重要预后因素。AFP≥500ng/ml 的患者的总生存率和癌症特异性生存率均明显低于 AFP<500ng/ml 的患者（p<0.05）。其他因素与肺转移瘤切除术后的生存无关。
血清 AFP 水平可能是预测 HCC 转移所需肺转移瘤切除术结果的有价值指标。
