Nagorney D M, van Heerden J A, Ilstrup D M, Adson M A
Department of Surgery, Mayo Clinic Rochester, Minn 55905.
Surgery. 1989 Oct;106(4):740-8; discussion 748-9.
To further define the clinicopathologic features and determinants of survival, we reviewed the cases of 110 patients with primary hepatic malignancy managed surgically between 1975 and 1986. Presenting signs of symptoms were pain (57%), fatigue (48%), abdominal mass (40%), and weight loss (33%). Twenty-six percent of patients had a history of hepatitis or cirrhosis. Histopathologically, tumors were hepatocarcinoma (72%), fibrolamellar variant (7%), cholangiocarcinoma (9%), mixed (7%), and other (5%). Resectability rate with curative intention was 67%. Exploration and biopsy alone was performed in 27% and palliative resection in 6%. Hospital mortality was 9%, and serious morbidity was 22%. Perioperative morbidity and mortality were significantly associated with operative blood loss. Median survival was 12.6 months, with a 5-year survival of 18%. Median survival after curative resection was 22.8 months, and 5-year survival was 27%. Univariate analysis showed that female sex, normal performance status, well-differentiated tumor, and curative resection were associated with increased survival; cholangiocarcinoma, nodal metastases, cirrhosis, hypocalcemia, prolonged prothrombin time, and increased serum transaminase and alkaline phosphatase were associated with decreased survival. Cox multivariate analysis showed that curative resection, normal performance status, and well-differentiated tumors were associated with increased survival, and prolonged prothrombin time and hypocalcemia were associated with decreased survival.
为进一步明确原发性肝癌的临床病理特征及生存决定因素，我们回顾了1975年至1986年间接受手术治疗的110例原发性肝癌患者的病例。主要症状体征包括疼痛（57%）、乏力（48%）、腹部肿块（40%）及体重减轻（33%）。26%的患者有肝炎或肝硬化病史。组织病理学检查显示，肿瘤类型为肝细胞癌（72%）、纤维板层样变异型（7%）、胆管癌（9%）、混合型（7%）及其他类型（5%）。根治性切除率为67%。仅行探查及活检的患者占27%，姑息性切除的患者占6%。医院死亡率为9%，严重并发症发生率为22%。围手术期并发症及死亡率与术中失血显著相关。中位生存期为12.6个月，5年生存率为18%。根治性切除后的中位生存期为22.8个月，5年生存率为27%。单因素分析显示，女性、体能状态正常、肿瘤高分化及根治性切除与生存率提高相关；胆管癌、淋巴结转移、肝硬化、低钙血症、凝血酶原时间延长及血清转氨酶和碱性磷酸酶升高与生存率降低相关。Cox多因素分析显示，根治性切除、体能状态正常及肿瘤高分化与生存率提高相关，凝血酶原时间延长及低钙血症与生存率降低相关。
