边缘性肝切除术治疗单发肝细胞癌患者的预后影响：来自 570 例肝切除术的证据。

Prognostic impact of marginal resection for patients with solitary hepatocellular carcinoma: evidence from 570 hepatectomies.

机构信息

Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan.

出版信息

Surgery. 2012 Apr;151(4):526-36. doi: 10.1016/j.surg.2011.12.002. Epub 2012 Jan 11.

DOI:10.1016/j.surg.2011.12.002

PMID:22244181

Abstract

BACKGROUND

During resection of a hepatocellular carcinoma, surgeons encounter occasionally a situation where marginal resection is inevitable because of a close association between the hepatocellular carcinoma and major vasculature and/or underlying impaired liver function. We investigated the impact of marginal resection on recurrence-free survival after a resection of a solitary hepatocellular carcinoma.

METHODS

The data of 570 patients who underwent macroscopically curative hepatectomy for a solitary hepatocellular carcinoma in our institution between 1990 and 2007 were analyzed. Marginal resection and non-marginal resection were defined as a cancer-negative surgical margin of ≤ 1 mm and a surgical margin of >1 mm, respectively. The macroscopic appearance of the hepatocellular carcinoma was classified as the simple nodular type or non-simple nodular type based on the classification of the Liver Cancer Study Group of Japan, and patients were categorized into 4 groups: group A, simple nodular type with cirrhosis; group B, simple nodular type without cirrhosis; group C, non-simple nodular type with cirrhosis; and group D, non-simple nodular type without cirrhosis.

RESULTS

The surgical margins were diagnosed as cancer-positive in 31 patients, as marginal resection in 165 patients, and as non-marginal resection in 374 patients. The marginal resection group showed a better recurrence-free survival than the positive surgical margin group (P = .001), and also a worse recurrence-free survival than the non-marginal resection group (P = .003). In groups A, B, and C, the recurrence-free survival rates were similar between marginal resection and non-marginal resection patients (P = .458), while in group D, marginal resection was a significant poor prognostic factor of recurrence-free survival in both univariate and multivariate analyses.

CONCLUSION

Marginal resection is acceptable in group A, B, and C patients, because it did not negatively affect postoperative recurrence-free survival.

摘要

背景

在肝细胞癌切除术中，由于肝癌与大血管和/或基础肝功能受损之间的密切关系，有时不可避免地需要进行边缘性切除。我们研究了边缘性切除对我院 1990 年至 2007 年间行根治性肝切除术的单发肝细胞癌患者无复发生存的影响。

方法

分析了我院 570 例单发肝细胞癌患者的资料，这些患者均接受了根治性肝切除术。边缘性切除和非边缘性切除定义为癌切缘≤1mm 和癌切缘>1mm。根据日本肝癌研究组的分类，将肝细胞癌的大体外观分为单纯结节型或非单纯结节型，并将患者分为 4 组：A 组，单纯结节型合并肝硬化；B 组，单纯结节型不合并肝硬化；C 组，非单纯结节型合并肝硬化；D 组，非单纯结节型不合并肝硬化。

结果

31 例手术切缘诊断为阳性，165 例为边缘性切除，374 例为非边缘性切除。边缘性切除组的无复发生存率优于阳性切缘组（P=0.001），也差于非边缘性切除组（P=0.003）。在 A、B 和 C 组中，边缘性切除组和非边缘性切除组的无复发生存率无差异（P=0.458），而在 D 组，边缘性切除是影响无复发生存率的独立预后不良因素。