Portolani Nazario, Baiocchi Gian Luca, Gheza Federico, Molfino Sarah, Lomiento Daniele, Giulini Stefano Maria
Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy.
World J Surg Oncol. 2014 Sep 25;12:298. doi: 10.1186/1477-7819-12-298.
The clinical course of peritoneal and parietal recurrence of hepatocellular carcinoma (HCC-PPL) is not well known.
Twenty-eight patients with a histologically proven HCC-PPL were analyzed out of a series of 515 patients operated for HCC (group 1). The risk factors, histological features, growing dynamic and results of surgical treatment were analyzed and compared with patients having other extrahepatic localizations of HCC (group 2; 26 patients). Survival data were also compared with patients with intrahepatic-only recurrence (group 3; 211 patients).
In group 1, a needle tract injury was present in 57.1% and a previous spontaneous rupture in 14.3% of cases. Parietal seeding was generally single, while peritoneal seeding was frequently multiple. Grading was poor in 84.7%, microvascular infiltration was observed in 57.1% and a rapid growth in 55.5% of cases. In Group 2, only 4 out of 26 patients underwent surgery. Survival was significantly better in group 3 than in group 1, and in group 1 than in group 2.
Extrahepatic HCC recurrence is related to an aggressive biology of the cancer; many characteristics of high malignancy are usually present in these cases. After radical surgery for HCC-PPL, an acceptable survival may be obtained.
肝细胞癌腹膜和壁层复发（HCC-PPL）的临床病程尚不清楚。
在515例接受肝癌手术的患者系列中，分析了28例经组织学证实为HCC-PPL的患者（第1组）。分析了危险因素、组织学特征、生长动态和手术治疗结果，并与肝癌其他肝外定位的患者（第2组；26例患者）进行比较。生存数据也与仅肝内复发的患者（第3组；211例患者）进行比较。
在第1组中，57.1%的病例存在针道损伤，14.3%的病例有既往自发性破裂。壁层种植通常为单发，而腹膜种植常为多发。84.7%的病例分级较差，57.1%的病例观察到微血管浸润，55.5%的病例生长迅速。在第2组中，26例患者中只有4例接受了手术。第3组的生存率明显高于第1组，第1组的生存率高于第2组。
肝外肝癌复发与癌症的侵袭性生物学有关；这些病例通常具有许多高恶性特征。对HCC-PPL进行根治性手术后，可获得可接受的生存率。
