Tsujita Eiji, Yamashita Yo-Ichi, Takeishi Kazuki, Matsuyama Ayumi, Tsutsui Shin-Ichi, Matsuda Hiroyuki, Toshima Takeo, Taketomi Akinobu, Shirabe Ken, Ishida Teruyoshi, Maehara Yoshihiko
Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan.
Am Surg. 2012 Apr;78(4):419-25.
The purpose of this study was to determine the poor prognostic factors after repeat hepatectomy (Hx) in patients with recurrent hepatocellular carcinoma (HCC). Overall survival rates and clinicopathological variables in 112 patients with repeat Hx from 1992 to 2010 were compared with those in 531 patients who underwent a primary Hx. To clarify the poor prognosis factors after repeat Hx, survival data among 112 patients were univariately and multivariately analyzed. Overall survival after repeat Hx was similar for that of the patients who underwent a primary Hx. The mean age of repeat Hx group was significantly higher, and a well-preserved liver function was recognized than the primary Hx group. Multivariate analysis revealed that: 1) indocyanine green retention rate at 15 minutes; 2) disease-free interval; 3) tumor size; 4) portal vein invasion at primary Hx; 5) gender; and 6) estimated blood loss to be an independent and significant poor prognostic factors. The overall 3-year postrecurrence overall survival rates were 100, 91.3, 59.6, and 0 per cent at risk number (R) R0, R1/2, R3, R4, respectively (P < 0.05). Repeat Hx provided a good compatible prognosis with primary Hx. In our findings, five risk factors to predict poor outcomes after repeat Hx were useful. Patients with recurrent HCC do not have universally poor outcomes, and our simple scoring system using five poor prognostic factors could serve to advise the prognosis and the potential benefit for patient selection about repeat Hx.
本研究的目的是确定复发性肝细胞癌（HCC）患者再次肝切除术后的不良预后因素。将1992年至2010年112例行再次肝切除术患者的总生存率和临床病理变量与531例行初次肝切除术患者的进行比较。为明确再次肝切除术后的不良预后因素，对112例患者的生存数据进行单因素和多因素分析。再次肝切除术后的总生存率与初次肝切除术后相似。再次肝切除组的平均年龄显著更高，且肝功能保存情况优于初次肝切除组。多因素分析显示：1）15分钟吲哚菁绿滞留率；2）无病间期；3）肿瘤大小；4）初次肝切除时门静脉侵犯；5）性别；6）估计失血量是独立且显著的不良预后因素。复发后总体3年总生存率在风险数（R）为R0、R1/2、R3、R4时分别为100%、91.3%、59.6%和0%（P<0.05）。再次肝切除与初次肝切除的预后良好且相似。在我们的研究结果中，五个预测再次肝切除术后不良结局的风险因素很有用。复发性HCC患者并非普遍预后不良，我们使用五个不良预后因素的简单评分系统可用于指导预后以及为患者选择再次肝切除提供潜在获益建议。
