Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
Am J Surg. 2014 Jun;207(6):863-9. doi: 10.1016/j.amjsurg.2013.06.009. Epub 2013 Oct 8.
In patients with solitary hepatocellular carcinoma ≤5 cm without macrovascular invasion, it is unknown whether the initial anatomic resection improves the long-term survival.
Among 545 initial hepatectomies for hepatocellular carcinoma between 2000 and 2012, the 233 patients with the aforementioned criteria of hepatocellular carcinoma were enrolled.
The mean observation time was 1,125 days. Disease-free 5-year survival rates with and without anatomic resection were 46% and 23%, respectively (P = .009). Multivariate analyses for disease-free survival rates revealed the risk factors to be α-fetoprotein (odds ratio, 1.6; P = .028) and anatomic resection (odds ratio, .7; P = .048), while increased Child-Pugh score (>5) was the only independent risk factor for overall survival (odds ratio, 1.8; P = .043). The 5-year overall survival rates with and without Child-Pugh score 5 were 74% and 40%, respectively (P < .0001, log-rank test).
Initial anatomic resection for small solitary hepatocellular carcinoma without macrovascular invasion improved disease-free survival rates remarkably.
对于无大血管侵犯的直径≤5cm 的单发肝细胞癌患者，目前尚不清楚初始解剖性肝切除术是否能改善长期生存。
在 2000 年至 2012 年间进行的 545 例初始肝切除术治疗肝细胞癌的患者中，纳入了符合上述肝细胞癌标准的 233 例患者。
平均观察时间为 1125 天。无解剖性肝切除和有解剖性肝切除患者的无病 5 年生存率分别为 46%和 23%（P=0.009）。无病生存率的多因素分析显示，独立的危险因素为甲胎蛋白（比值比，1.6；P=0.028）和解剖性肝切除（比值比，0.7；P=0.048），而增加的 Child-Pugh 评分（>5）是总生存的唯一独立危险因素（比值比，1.8；P=0.043）。Child-Pugh 评分为 5 分的患者和未达到 5 分的患者的 5 年总生存率分别为 74%和 40%（P<0.0001，对数秩检验）。
对于无大血管侵犯的小的单发肝细胞癌患者，初始解剖性肝切除术可显著提高无病生存率。
