Mount Sinai Liver Cancer Program, Mount Sinai Medical Center, New York, NY 10029, USA.
Ann Surg. 2012 Jun;255(6):1135-43. doi: 10.1097/SLA.0b013e31823e70a3.
The aim of this study was to examine the features and outcomes of noncirrhotic patients undergoing resection for hepatocellular carcinoma.
Ten percent to 40% of hepatocellular carcinoma cases arise within a noncirrhotic liver parenchyma. Resection is the standard therapy, yet the published resection series from the West are small.
From January 1987 to December 2009, our center performed 206 partial liver resections for nonfibrotic or minimally fibrotic (Scheuer stage 0-2) hepatocellular carcinoma. We retrospectively reviewed these cases and performed univariate and multivariate analyses for predictors of long-term outcomes.
Eighty-one patients (39.3%) had chronic hepatitis B infection and 23 patients (11.2%) had chronic hepatitis C. The remaining 83 (39.8%) had no underlying liver disease. Average age was 60.2 years, and 68.4% of the patients were male. Average tumor size was 8.2 cm. Overall survival at 5 years was 46.3%. Recurrence at 5 years was 50.0%. Independent predictors for decreased survival were tumor size larger than 7.0 cm, creatinine more than 1.0 mg/dL, satellite nodules, albumin less than 3.5 gm/dL, alpha-fetoprotein more than 100 ng/mL, and any vascular invasion. Chronic hepatitis B virus infection predicted longer survival. Independent predictors for decreased time to recurrence were albumin less than 3.5 gm/dL, any vascular invasion, age more than 60 years, tumor size larger than 7.0 cm, and alpha-fetoprotein more than 100 ng/mL. Treatment of recurrence with either repeat resection or ablation was associated with a median survival of 50.4 months from time of recurrence.
Hepatocellular carcinoma can develop in a minimally fibrotic hepatitis C patient. Tumor-related factors such as vascular invasion primarily determine long-term outcomes. Hepatitis B virus-associated tumors seem to have a better prognosis in the nonfibrotic or minimally fibrotic population. Aggressive treatment of recurrence is warranted.
本研究旨在探讨非肝硬化患者行肝细胞癌切除术的特征和结局。
10%至 40%的肝细胞癌病例发生在非肝硬化的肝实质内。切除术是标准治疗方法，但西方发表的切除术系列报道数量较少。
自 1987 年 1 月至 2009 年 12 月，我们中心对 206 例非纤维性或轻度纤维性（Scheuer 分期 0-2）肝细胞癌患者进行了部分肝切除术。我们对这些病例进行了回顾性分析，并进行了单因素和多因素分析，以预测长期结局的预测因素。
81 例患者（39.3%）有慢性乙型肝炎感染，23 例患者（11.2%）有慢性丙型肝炎。其余 83 例（39.8%）无潜在肝脏疾病。平均年龄为 60.2 岁，68.4%的患者为男性。平均肿瘤大小为 8.2cm。5 年总生存率为 46.3%。5 年内复发率为 50.0%。生存时间缩短的独立预测因素包括肿瘤直径大于 7.0cm、肌酐大于 1.0mg/dL、卫星结节、白蛋白小于 3.5gm/dL、甲胎蛋白大于 100ng/mL 和任何血管侵犯。慢性乙型肝炎病毒感染预测生存时间较长。复发时间缩短的独立预测因素包括白蛋白小于 3.5gm/dL、任何血管侵犯、年龄大于 60 岁、肿瘤直径大于 7.0cm 和甲胎蛋白大于 100ng/mL。复发后行再次切除术或消融治疗，从中位复发时间起的中位生存时间为 50.4 个月。
丙型肝炎患者可能在非纤维化或轻度纤维化的情况下发生肝细胞癌。肿瘤相关因素，如血管侵犯，主要决定长期结局。乙型肝炎病毒相关肿瘤在非纤维化或轻度纤维化人群中似乎预后较好。需要积极治疗复发。
