Faber Wladimir, Sharafi Siamak, Stockmann Martin, Dennecke Timm, Bahra Marcus, Klein Fritz, Malinowski Maciej B, Schott Eckart, Neuhaus Peter, Seehofer Daniel
Hepatogastroenterology. 2014 Oct;61(135):1925-30.
BACKGROUND/AIMS: Data about the clinical course after liver resection for HCC in non-cirrhotic liver (NCL) is rare in western countries. Although the patients with HCC in NCL tolerate major liver resections, it is less clear if an underlying steatosis or NASH increase the perioperative and postoperative risk. The purpose of this study was to characterize the clinical course after hepatic resection in patients with HCC in the absence of liver cirrhosis and in the absence of viral hepatitis.
The data of 148 patients with HCC in non-cirrhotic liver, who underwent curatively intented liver resection, were analyzed. Patients with hepatitis B or C infection were excluded. Patients with fibrolamellar HCC or liver cirrhosis or fibrosis higher than grade 2 according to the Desmet-Scheuer score were also excluded.
The overall 1-, 3- and 5-year survival rates were 75.4%, 54.7% and 38.9%. Increased patient age (elder than 70 years) influenced the cumulative survival significantly. Especially the combination of increased patient age and major resection (>2 segments) at once influenced the cumulative survival. The overall postoperative morbidity was 37.8 %. No intraoperative death was observed. Postoperative increased leucocytes, urea and creatinin increased the postoperative complications. In the subgroup with major resection increased GGT correlated with steatosis, and raised AST correlated with elevated patient age.
In Western countries HCC in non-cirrhotic liver is rare. Liver resection is safe and is the only curative therapy option for the time by HCC without liver cirrhosis. Further studies are necessary for identification of more prognostic factors and optionally special treatment
背景/目的：在西方国家，关于非肝硬化性肝（NCL）中肝癌肝切除术后临床病程的数据很少。尽管NCL中肝癌患者能够耐受大的肝切除术，但潜在的脂肪变性或非酒精性脂肪性肝炎（NASH）是否会增加围手术期和术后风险尚不清楚。本研究的目的是描述无肝硬化且无病毒性肝炎的肝癌患者肝切除术后的临床病程。
分析了148例非肝硬化性肝中肝癌且接受根治性肝切除术的患者的数据。排除了乙型或丙型肝炎感染患者。也排除了纤维板层型肝癌、肝硬化或根据Desmet-Scheuer评分纤维化程度高于2级的患者。
1年、3年和5年总生存率分别为75.4%、54.7%和38.9%。患者年龄增加（大于70岁）对累积生存率有显著影响。特别是患者年龄增加与一次性进行大的肝切除（>2个肝段）相结合对累积生存率有影响。术后总体发病率为37.8%。未观察到术中死亡。术后白细胞、尿素和肌酐升高增加了术后并发症。在大肝切除亚组中，γ-谷氨酰转移酶（GGT）升高与脂肪变性相关，天冬氨酸氨基转移酶（AST）升高与患者年龄增加相关。
在西方国家，非肝硬化性肝中的肝癌很少见。肝切除是安全的，是目前无肝硬化肝癌唯一的根治性治疗选择。需要进一步研究以确定更多的预后因素，并可能进行特殊治疗。
