Hirokawa Fumitoshi, Hayashi Michihiro, Miyamoto Yoshiharu, Asakuma Mitsuhiro, Shimizu Tetsunosuke, Komeda Koji, Inoue Yoshihiro, Uchiyama Kazuhisa
Hepatogastroenterology. 2015 Jan-Feb;62(137):164-8.
BACKGROUND/AIMS: The prevention of recurrence is important for improving long-term outcome for HCC. To identify candidates for postoperative adjuvant therapy after curative hepatectomy for HCC in Child-Pugh classification A (Child A).
Of 157 patients who underwent initial hepatectomy for Child A HCC, 93 had recurrence and were divided into 2 groups: group A, ≤2 tumors, each <3 cm in size at the time of intrahepatic recurrence; group B, ≥3 tumors or tumor ≥3 cm in size at the time of intrahepatic recurrence and/or extrahepatic recurrence. Clinicopathological and survival data were analyzed retrospectively in each group to identify poor prognostic factors.
The 1-year recurrence rate was 50%, and the time to recurrence was shorter in group B (10 months) than in group A (20 months) Overall 1-, 3-, and 5-year survival rates were poorer in group B (83%, 52%, and 35% respectively; p < 0.001) than in group A (100%, 96%, and 71% respectively) Cancer spread (vascular invasion and/or intrahepatic metastasis) was significantly affecting the recurrence pattern of Group B (p=0.0238) on multivariate analysis.
Systemic adjuvant chemotherapy af ter curative hepatectomy for HCC in Child A should be given to patients with microscopic vascular invasion and/or intrahepatic metastasis.
背景/目的：预防复发对于改善肝癌的长期预后很重要。为了确定Child-Pugh A级（Child A）肝癌根治性肝切除术后辅助治疗的候选者。
在157例行Child A级肝癌初次肝切除术的患者中，93例出现复发，分为2组：A组，肝内复发时肿瘤数量≤2个，每个肿瘤大小<3 cm；B组，肝内复发时肿瘤数量≥3个和/或肿瘤大小≥3 cm和/或肝外复发。对每组的临床病理和生存数据进行回顾性分析，以确定不良预后因素。
1年复发率为50%，B组（10个月）的复发时间短于A组（20个月）。B组的总体1年、3年和5年生存率（分别为83%、52%和35%；p<0.001）低于A组（分别为100%、96%和71%）。多因素分析显示，癌症扩散（血管侵犯和/或肝内转移）对B组的复发模式有显著影响（p=0.0238）。
对于Child A级肝癌根治性肝切除术后有微小血管侵犯和/或肝内转移的患者，应给予全身辅助化疗。
