Kim Jong Man, Kwon Choon Hyuck David, Joh Jae-Won, Park Jae Berm, Lee Joon Hyeok, Kim Sung Joo, Paik Seung Woon, Park Cheol Keun
Hepatogastroenterology. 2015 Mar-Apr;62(138):399-404.
BACKGROUND/AIMS: The characteristics of multiple nudules in hepatocellular carcinomas (HCCs) after curative liver resection remain obscure. We compare the clinicopathologic characteristics and prognoses between patients with hepatic lesions with multicentric occurrence (MO) and intrahepatic metastasis (IM) at the time of surgical resection.
The histopathologic features of multiple tumors from 198 patients of HCC were analyzed and divided into MO group (n = 51, 25.8%) for multicentric HCCs and an IM group (n = 147, 74.2%) in cases with intrahepatic metastases. Overall survival rate, disease-free survival and clinicopathologic differences were compared between the two groups.
Microvascular invasion and increased tumor size were the most important factors discriminating the IM group from the MO group (P < 0.001 and P = 0.027, respectively). Kaplan-Meier and log rank tests revealed that disease-free survival and overall survival rates in the MO group were significantly higher than those for the IM group (P < 0.001 and P < 0.001, respectively). A multivariate analysis of Cox's proportional hazards model showed that increased alpha-fetoprotein (AFP) and protein induced by vitamin K antagonist-II (PIVKA-II) levels, portal vein invasion and intrahepatic metastases were the most important prognostic factors.
Among HCCs, the prognosis of patients with MO is significantly better than that of patients with IM.
背景/目的：根治性肝切除术后肝细胞癌（HCC）多发结节的特征仍不清楚。我们比较手术切除时肝内病变多中心发生（MO）和肝内转移（IM）患者的临床病理特征及预后。
分析198例HCC患者多灶肿瘤的组织病理学特征，分为多中心HCC的MO组（n = 51，25.8%）和肝内转移的IM组（n = 147，74.2%）。比较两组的总生存率、无病生存率及临床病理差异。
微血管侵犯和肿瘤大小增加是区分IM组和MO组的最重要因素（分别为P < 0.001和P = 0.027）。Kaplan-Meier法和对数秩检验显示，MO组的无病生存率和总生存率显著高于IM组（分别为P < 0.001和P < 0.001）。Cox比例风险模型多因素分析显示，甲胎蛋白（AFP）和维生素K拮抗剂-II诱导蛋白（PIVKA-II）水平升高、门静脉侵犯和肝内转移是最重要的预后因素。
在HCC中，MO患者的预后明显优于IM患者。
