Kim Jin-Min, Lee Seung-Hyun, Shin Woo Young, Lee Keon-Young, Kim Jun Mee, Ahn Seung-Ik
Department of Surgery, Inha University School of Medicine, Incheon, South Korea.
Department of Pathology, Inha University School of Medicine, Incheon, South Korea.
ANZ J Surg. 2018 Dec;88(12):E840-E844. doi: 10.1111/ans.14824. Epub 2018 Sep 17.
Intrahepatic recurrence is the major cause of management failure after surgical resection of hepatocellular carcinoma (HCC). In the present study, we analysed intrahepatic recurrence by HCC distribution using Couinaud's liver segments.
Recurrence proximity levels were defined with respect to primary tumour locations from Level LR (locoregional) to Level IV. Initial and recurrent tumours were compared with segmental distribution of their locations, and recurrence proximity levels were compared with initial tumour locations and disease-free survival.
Eighty-five (58.2%) of 146 patients with single nodular HCC experienced intrahepatic recurrence after surgical resection with a mean disease-free survival of 20.8 ± 21.1 months. Segmental distributions of initial and recurrent tumour locations were not significantly different (P > 0.05), and both were similar to the normal segmental volume distribution except segments S5, S6 and S8. Recurrences in proximity levels LR to IV were 11.1%, 34.9%, 25.4%, 21.4%, and 7.1%, respectively, and this distribution agreed well with theoretical proximity level distribution (P > 0.05). Disease-free survivals for different recurrence levels were not different (P = 0.530).
Intrahepatic recurrences after surgical resection of single nodular HCC occurred evenly in the remnant liver, and the timing was independent of the proximity between initial and recurrent tumours. Prevention was found to be proportional to the amount of liver segments removed. Surgical plans should take this into consideration.
肝内复发是肝细胞癌（HCC）手术切除后治疗失败的主要原因。在本研究中，我们利用Couinaud肝段分析了HCC分布的肝内复发情况。
根据原发肿瘤位置从LR（局部区域）水平到IV级定义复发接近水平。将初始肿瘤和复发肿瘤与其位置的节段分布进行比较，并将复发接近水平与初始肿瘤位置和无病生存期进行比较。
146例单结节HCC患者中有85例（58.2%）在手术切除后发生肝内复发，平均无病生存期为20.8±21.1个月。初始肿瘤和复发肿瘤位置的节段分布无显著差异（P>0.05），除S5、S6和S8节段外，两者均与正常节段体积分布相似。接近水平LR至IV的复发率分别为11.1%、34.9%、25.4%、21.4%和7.1%，该分布与理论接近水平分布吻合良好（P>0.05）。不同复发水平的无病生存期无差异（P=0.530）。
单结节HCC手术切除后的肝内复发在残余肝脏中均匀发生，且时间与初始肿瘤和复发肿瘤之间的接近程度无关。发现预防措施与切除的肝段数量成正比。手术计划应考虑到这一点。
