Liang Bin-yong, Huang Zhi-yong, Liu Yang-an, Hou Ping, Ji Gui-bao, Chen Xiao-ping
Huazhong University of Science and Technology, Wuhan, China.
Zhonghua Wai Ke Za Zhi. 2012 Oct;50(10):865-9.
To compare the outcomes after liver resection for a single small hepatocellular carcinoma (HCC) (≤ 5 cm) between non-cirrhotic patients and cirrhotic patients, and to explore the influence of liver cirrhosis on recurrence and overall survival after liver resection in patients with a single small HCC.
A consecutive series of 256 patients with a single small HCC undergoing liver resection from April 2001 to October 2009 was retrospectively reviewed. Among the 256 patients, 227 patients were male, and 29 were female. The medium age was 49 years (ranged, 14 - 79 years); 224 (87.5%) patients were positive for hepatitis B surface antigen, 241 (94.1%) patients were with preoperative liver function of Child-Pugh grade A. The entire cohort were divided into non-cirrhosis group (n = 44) and cirrhosis group (n = 212). Univariate analysis and then multivariate analysis were performed to determine the prognostic factors of recurrence and overall survival after liver resection for all patients.
The 1-, 3-, 5-year recurrence-free survival rates after liver resection were 93.0%, 85.3%, and 68.5%, respectively, in non-cirrhosis group, while 81.1%, 58.6%, and 45.0%, respectively, in cirrhosis group. The 1-, 3-, 5-year overall survival rates after liver resection were 100%, 92.5%, and 92.5%, respectively, in non-cirrhosis group, while 93.8%, 78.7%, and 67.8%, respectively, in cirrhosis group. Both the recurrence-free survival and overall survival of non-cirrhosis group were significantly better than those of cirrhosis group (χ(2) = 8.756, P = 0.003; χ(2) = 8.603, P = 0.003). Cirrhosis, absence of tumor capsule, presence of microvascular invasion and moderate/poor tumor differentiation were the independent adverse prognostic factors for recurrence-free survival and overall survival in patients with a single small HCC after liver resection.
Cirrhosis is an important adverse prognostic factor for long-term survival in patients with a single small HCC after liver resection. Liver resection resulted in much worse survival for cirrhotic patients compared to non-cirrhotic patients.
比较非肝硬化患者与肝硬化患者行肝切除治疗单个小肝细胞癌（HCC）（≤5 cm）后的结局，并探讨肝硬化对单个小HCC患者肝切除术后复发及总生存的影响。
回顾性分析2001年4月至2009年10月连续收治的256例行肝切除治疗单个小HCC的患者。256例患者中，男性227例，女性29例。中位年龄49岁（范围14 - 79岁）；224例（87.5%）乙肝表面抗原阳性，241例（94.1%）术前肝功能为Child-Pugh A级。将整个队列分为非肝硬化组（n = 44）和肝硬化组（n = 212）。对所有患者进行单因素分析，然后进行多因素分析，以确定肝切除术后复发和总生存的预后因素。
非肝硬化组肝切除术后1年、3年、5年无复发生存率分别为93.0%、85.3%、68.5%，而肝硬化组分别为81.1%、58.6%、45.0%。非肝硬化组肝切除术后1年、3年、5年总生存率分别为100%、92.5%、92.5%，而肝硬化组分别为93.8%、78.7%、67.8%。非肝硬化组的无复发生存率和总生存率均显著优于肝硬化组（χ(2)=8.756，P = 0.003；χ(2)=8.603，P = 0.003）。肝硬化、无肿瘤包膜、存在微血管侵犯及肿瘤中/低分化是单个小HCC患者肝切除术后无复发生存和总生存的独立不良预后因素。
肝硬化是单个小HCC患者肝切除术后长期生存的重要不良预后因素。与非肝硬化患者相比，肝切除对肝硬化患者生存的影响更差。
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