Sonohara Fuminori, Nomoto Shuji, Inokawa Yoshikuni, Kanda Mitsuro, Yamada Suguru, Fujii Tsutomu, Sugimoto Hiroyuki, Kodera Yasuhiro
From the Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine (FS, SN, YI, MK, SY, TF, HS, YK); and Department of Surgery, Aichi-Gakuin University School of Dentistry, Nagoya, Japan (FS, SN, YI).
Medicine (Baltimore). 2015 Mar;94(9):e602. doi: 10.1097/MD.0000000000000602.
The purpose of this study was to clarify the individual prognostic factors after curative and primary resection of hepatocellular carcinoma (HCC).Reliable prognostic factors and tumor staging for HCC have been required to predict an appropriate prognosis. However, in HCC, no staging system has received universal acceptance, and several tumor factors seem to relate to HCC prognosis, but they are not definitive. At present, few studies have mentioned the importance of serosal invasion as a prognostic factor.A retrospective search of our database identified 214 consecutive patients who underwent primary and curative hepatectomy for HCC at our department between January 1998 and December 2011. Risk factors for recurrence-free survival (RFS) and overall survival (OS) were analyzed with Cox proportional hazard model, Kaplan-Meier method, and log-rank tests.Multivariate analyses showed that serosal invasion (hazard ratio [HR], 2.75; P = 0.0005) and vascular invasion (HR, 1.71; P = 0.0331) were independently correlated with RFS. Serosal invasion was significantly correlated with HCC recurrence (P = 0.0230). The Kaplan-Meier method and log-rank tests revealed that the patients with serosal invasion showed significantly worse prognosis both in RFS (P < 0.0001) and OS (P = 0.0016).Serosal invasion should be regarded as a strong independent predictor for recurrence in curatively resected HCC cases.
本研究的目的是阐明肝细胞癌（HCC）根治性初次切除术后的个体预后因素。需要可靠的HCC预后因素和肿瘤分期来预测合适的预后。然而，在HCC中，没有一种分期系统得到普遍认可，并且有几种肿瘤因素似乎与HCC预后相关，但并不确定。目前，很少有研究提及浆膜侵犯作为预后因素的重要性。对我们的数据库进行回顾性检索，确定了1998年1月至2011年12月期间在我科连续接受HCC根治性初次肝切除术的214例患者。采用Cox比例风险模型、Kaplan-Meier法和对数秩检验分析无复发生存期（RFS）和总生存期（OS）的危险因素。多因素分析显示，浆膜侵犯（风险比[HR]，2.75；P = 0.0005）和血管侵犯（HR，1.71；P = 0.0331）与RFS独立相关。浆膜侵犯与HCC复发显著相关（P = 0.0230）。Kaplan-Meier法和对数秩检验显示，浆膜侵犯患者的RFS（P < 0.0001）和OS（P = 0.0016）预后均显著较差。浆膜侵犯应被视为根治性切除HCC病例复发的强大独立预测因素。
