一家三级医疗机构中巨大肝细胞癌切除的结果：大小重要吗？
Outcomes of resection of giant hepatocellular carcinoma in a tertiary institution: does size matter?
作者信息
Thng Yongxian, Tan Jarrod K H, Shridhar Iyer G, Chang Stephen K Y, Madhavan Krishnakumar, Kow Alfred W C
机构信息
Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Department of Surgery, National University Health System Singapore, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
出版信息
HPB (Oxford). 2015 Nov;17(11):988-93. doi: 10.1111/hpb.12479. Epub 2015 Sep 3.
BACKGROUND
The surgical management of giant hepatocellular carcinoma (G-HCC), or HCC of ≥10 cm in diameter, remains controversial. The aim of this study was to compare the outcomes of surgical resection of, respectively, G-HCC and small HCC (S-HCC), or HCC measuring <10 cm.
METHODS
A retrospective review of all patients (n = 86) diagnosed with HCC and submitted to resection in a tertiary hospital during the period from January 2007 to June 2012 was conducted. Overall survival (OS), recurrence rates and perioperative mortality at 30 days were compared between patients with, respectively, G-HCC and S-HCC. Prognostic factors for OS were analysed.
RESULTS
The sample included 23 patients with G-HCC (26.7%) and 63 with S-HCC (73.3%) based on histological tumour size. Patient demographics and comorbidities were comparable. Median OS was 39.0 months in patients with G-HCC and 65.0 months in patients with S-HCC (P = 0.213). Although size did not affect OS in this cohort, the presence of satellite lesions [hazard ratio (HR) 3.70, P = 0.012] and perioperative blood transfusion (HR 2.85, P = 0.015) were negative predictors for OS.
CONCLUSIONS
Surgical resection of G-HCC provides OS comparable with that after resection of S-HCC.
背景
巨大肝细胞癌（直径≥10 cm的肝细胞癌）的手术治疗仍存在争议。本研究旨在比较巨大肝细胞癌（G-HCC）和小肝细胞癌（S-HCC，直径<10 cm的肝细胞癌）手术切除的结果。
方法
对2007年1月至2012年6月期间在一家三级医院诊断为肝细胞癌并接受手术切除的所有患者（n = 86）进行回顾性分析。比较G-HCC和S-HCC患者的总生存期（OS）、复发率和30天围手术期死亡率。分析OS的预后因素。
结果
根据组织学肿瘤大小，样本包括23例G-HCC患者（26.7%）和63例S-HCC患者（73.3%）。患者的人口统计学特征和合并症具有可比性。G-HCC患者的中位OS为39.0个月，S-HCC患者为65.0个月（P = 0.213）。虽然肿瘤大小在该队列中不影响OS，但卫星灶的存在[风险比（HR）3.70，P = 0.012]和围手术期输血（HR 2.85，P = 0.015）是OS的负性预测因素。
结论
G-HCC手术切除后的OS与S-HCC切除后的OS相当。
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