Tang Z Y, Yu Y Q, Zhou X D, Ma Z C, Yang R, Lu J Z, Lin Z Y, Yang B H
Liver Cancer Institute, Shanghai Medical University, People's Republic of China.
Cancer. 1989 Jul 15;64(2):536-41. doi: 10.1002/1097-0142(19890715)64:2<536::aid-cncr2820640230>3.0.co;2-x.
A long-term follow-up study of 144 cases with surgically and pathologically proved small hepatocellular carcinoma (less than or equal to 5 cm) from 1967 to 1987 is reported. One hundred eight cases (75.0%) were detected by alpha-fetoprotein serosurvey and/or ultrasonography mainly in a high-risk population; 129 cases (89.6%) coexisted with cirrhosis. Resection was done in 132 cases (91.7%) with three (2.3%) operative deaths; cryosurgery, laser vaporization, and hepatic arterial chemotherapy were used in the rest. Limited resection was done in 67.4% of resections. Reresection of subclinical recurrence or solitary pulmonary metastasis was done in 21 cases. The 5-year and 10-year survival rates were 67.9% and 53.4% in the resection group but zero in the nonresection group. Survival was correlated negatively with tumor size, 5-year survival after resection was 84.6% in tumors less than or equal to 2 cm but 59.5% in tumors of 4.1 to 5 cm. The increase of resectability and reresection resulted in marked improved of 5-year survival from 43.5% in 1973 to 1977 to 63.3% in 1978 to 1982 in the entire series. No significant difference was found between survival of limited resection and lobectomy. Resection may be the modality of choice for treatment of small hepatocellular carcinomas with compensated liver function. Limited resection instead of lobectomy was the key to increased resectability and decreased operative mortality in cirrhotic livers. Reresection of subclinical recurrence was important to prolong survival further.
本文报告了1967年至1987年间144例经手术及病理证实的小肝细胞癌（直径小于或等于5厘米）的长期随访研究结果。108例（75.0%）主要在高危人群中通过甲胎蛋白血清学检查和/或超声检查发现；129例（89.6%）合并肝硬化。132例（91.7%）接受了手术切除，其中3例（2.3%）手术死亡；其余患者采用了冷冻治疗、激光汽化和肝动脉化疗。67.4%的切除手术为局限性切除。21例对亚临床复发或孤立性肺转移进行了再次切除。切除组的5年和10年生存率分别为67.9%和53.4%，而非切除组为零。生存率与肿瘤大小呈负相关，切除术后肿瘤直径小于或等于2厘米者5年生存率为84.6%，而直径4.1至5厘米者为59.5%。可切除性和再次切除率的提高使整个系列的5年生存率从1973年至1977年的43.5%显著提高至1978年至1982年的63.3%。局限性切除与肝叶切除术的生存率无显著差异。对于肝功能代偿的小肝细胞癌，手术切除可能是首选的治疗方式。对于肝硬化肝脏，采用局限性切除而非肝叶切除术是提高可切除性和降低手术死亡率的关键。对亚临床复发进行再次切除对于进一步延长生存期很重要。
