Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
J Surg Oncol. 2013 Mar;107(4):408-13. doi: 10.1002/jso.23226. Epub 2012 Aug 17.
To evaluate the surgical outcome of patients with huge solitary hepatocellular carcinoma (HCC, ≥10 cm in diameter) without major vascular invasion.
We retrospectively studied 177 patients with huge HCC (≥10 cm in diameter) who underwent hepatectomy from 1990 to 2008. Surgical outcomes and clinicopathological characteristics were compared among 54 patients with solitary HCC without a major portal vein tumor thrombus (MPVT), 53 patients with multiple HCCs without MPVT, and 70 patients who have HCC with MPVT.
The mean tumor size and indocyanine green retention rate at 15 min showed no significant difference among patients groups. The overall 5-year survival rate was significantly higher in patients with solitary HCC (79%) than in patients with multiple HCCs (31%, P < 0.0001) and MPVT (17%, P < 0.0001). In patients who underwent curative surgery, the 5-year disease-free survival rate was significantly higher in patients with solitary HCC (48%) than in patients with multiple HCCs (12%, P = 0.0008) and MPVT (12%, P = 0.0003). Multivariate analysis showed solitary HCC to be a significant independent prognostic factor for overall survival and disease-free survival.
Patients with solitary HCC without MPVT show a favorable surgical outcome even for tumor size ≥10 cm in diameter.
评估无大血管侵犯的巨大单发肝细胞癌（HCC，直径≥10cm）患者的手术结果。
我们回顾性研究了 1990 年至 2008 年间接受肝切除术的 177 例巨大 HCC（直径≥10cm）患者。比较了 54 例无大门静脉癌栓（MPVT）的单发 HCC 患者、53 例无 MPVT 的多灶性 HCC 患者和 70 例伴有 MPVT 的 HCC 患者的手术结果和临床病理特征。
三组患者的肿瘤平均大小和吲哚菁绿 15 分钟滞留率无显著差异。单发 HCC 患者的总体 5 年生存率（79%）显著高于多灶性 HCC 患者（31%，P<0.0001）和伴有 MPVT 的 HCC 患者（17%，P<0.0001）。在接受根治性手术的患者中，单发 HCC 患者的 5 年无病生存率（48%）显著高于多灶性 HCC 患者（12%，P=0.0008）和伴有 MPVT 的 HCC 患者（12%，P=0.0003）。多因素分析显示，单发 HCC 是总体生存和无病生存的显著独立预后因素。
无 MPVT 的单发 HCC 患者即使肿瘤直径≥10cm，手术结果也良好。
