Liu Y, Dai Y, Zhang X X, Li S M, Liu R J, Fan H
Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Zhonghua Yi Xue Za Zhi. 2018 Jun 26;98(24):1937-1940. doi: 10.3760/cma.j.issn.0376-2491.2018.24.009.
To compare the efficacy and safety of anatomic hepatectomy and non-anatomic hepatectomy in the treatment of single small Hepatocellular carcinoma with MVI. The clinical data of 84 patients with single small Hepatocellular carcinoma with MVI in Beijing Chaoyang Hospital between January 2008 and December 2013 were retrospectively analyzed. Patients undergoing anatomical hepatectomy were enrolled in the AR group, and the patients undergoing non-anatomic hepatectomy were enrolled in the NR group. The efficacy and survival rate of the two groups were compared. (1) Operation time, numbers of patients with volume of intraoperative blood loss ≥300 ml and number of patients with blood transfusion were (170±41)minutes, 8, 7 in the AR group and (148±35)minutes, 19, 18 in the NR group, respectively, with statistically significant differences between the 2 groups (<0.05). (2) The 1-year, 2-year and 3-year overall survival rate were 85.7%, 68.6%, 57.1% in the AR group and 79.6%, 53.1%, 42.9% in the NR group, respectively. The 1-year, 2-year and 3-year progression-free survival rate were 80.0%, 62.9%, 51.4% in the AR group and 71.4%, 49.0%, 38.8%, in the NR group, respectively. There were statistically significant differences between the 2 groups both in the overall survival rate and the progression-free survival rate (<0.05). (3) Prognostic factors analysis of HCC patients with MVI: result of univariate analysis showed that maximum diameter of tumor and surgical procedures were relative factors affecting overall survival and progression-free survival of HCC patients with MVI, AFP level was relative factors affecting progression-free survival of HCC patients with MVI, with statistically significant differences (<0.05). Result of multivariate analysis showed that maximum diameter of tumor between 3.0 and 5.0 cm and non-anatomic liver resection were independent factors affecting poor overall survival and progression-free survival of HCC patients with MVI, and AFP≥20 μg/L and total bilirubin ≥20 μmol/L were independent factors affecting poor progression-free survival of HCC patients with MVI, with a statistically significant differences (< 0.05). Anatomic hepatectomy for patients with single small hepatocellular carcinoma with microvascular invasion has better clinical efficacy and safety.
比较解剖性肝切除术与非解剖性肝切除术治疗单发性小肝癌伴微血管侵犯（MVI）的疗效及安全性。回顾性分析2008年1月至2013年12月在北京朝阳医院就诊的84例单发性小肝癌伴MVI患者的临床资料。接受解剖性肝切除术的患者纳入AR组，接受非解剖性肝切除术的患者纳入NR组。比较两组的疗效及生存率。（1）手术时间、术中出血量≥300 ml的患者数及输血患者数在AR组分别为（170±41）分钟、8例、7例，在NR组分别为（148±35）分钟、19例、18例，两组比较差异有统计学意义（<0.05）。（2）AR组1年、2年、3年总生存率分别为85.7%、68.6%、57.1%，NR组分别为79.6%、53.1%、42.9%。AR组1年、2年、3年无进展生存率分别为80.0%、62.9%、51.4%，NR组分别为71.4%、49.0%、38.8%。两组总生存率及无进展生存率比较差异均有统计学意义（<0.05）。（3）MVI肝癌患者的预后因素分析：单因素分析结果显示，肿瘤最大径和手术方式是影响MVI肝癌患者总生存及无进展生存的相关因素，AFP水平是影响MVI肝癌患者无进展生存的相关因素，差异有统计学意义（<0.05）。多因素分析结果显示，肿瘤最大径在3.0至5.0 cm及非解剖性肝切除是影响MVI肝癌患者总生存及无进展生存不良的独立因素，AFP≥20 μg/L及总胆红素≥20 μmol/L是影响MVI肝癌患者无进展生存不良的独立因素，差异有统计学意义（<0.05）。解剖性肝切除术治疗单发性小肝癌伴微血管侵犯患者具有更好的临床疗效及安全性。
