Ueda Junji, Yoshida Hiroshi, Mamada Yasuhiro, Taniai Nobuhiko, Yoshioka Masato, Hirakata Atsushi, Kawano Youichi, Shimizu Tetsuya, Kanda Tomohiro, Takata Hideyuki, Uchida Eiji
Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School.
Department of Surgery, Nippon Medical School Tama Nagayama Hospital.
J Nippon Med Sch. 2018;85(4):221-227. doi: 10.1272/jnms.JNMS.2018_85-34.
Recently, some reports have revealed a relationship between post-hepatectomy prognosis in hepatocellular carcinoma (HCC) and hepatic fibrosis markers. We evaluated the relationship between these markers of hepatic fibrosis, clinicopathological findings, and prognosis.
Three hundred and sixty patients underwent hepatectomy for HCC in the Nippon Medical School Hospital between 1993 and 2013. We divided these patients into two groups: normal serum hyaluronic acid (HA) levels and abnormal levels. We also divided patients into groups with normal serum type IV collagen levels and abnormal levels.
The overall survival rate and recurrence-free survival rate of the normal group were significantly higher than those of the abnormal group. In the normal hyaluronic acid group, serum albumin and prothrombin time were significantly higher than in the abnormal group, and age, hepatitis C virus antibody (HCV)-Ab positivity, Child-Pugh grade B, liver cirrhosis, indocyanine green retention rate at 15 min (ICGR15), type IV collagen level, and type IV collagen 7s level were significantly lower than those in the abnormal group. In the normal type IV collagen group, HCV-Ab positivity, liver cirrhosis, ICGR15, HA level, and type IV collagen 7s level were significantly lower than those in the abnormal group, and the serum albumin level was significantly higher than that in the abnormal group. Multivariate analysis independently revealed the significant effect of serum type IV collagen on the overall survival rate as well as the significant effect of serum HA on the recurrence-free survival rate in patients who underwent hepatectomy for HCC.
Preoperative examinations of serum hyaluronic acid levels and type IV collagen levels are imperative for hepatic resection for HCC because these markers are significantly associated with liver function and prognosis.
最近，一些报告揭示了肝细胞癌（HCC）肝切除术后预后与肝纤维化标志物之间的关系。我们评估了这些肝纤维化标志物、临床病理特征与预后之间的关系。
1993年至2013年期间，360例患者在日本医科大学医院接受了HCC肝切除术。我们将这些患者分为两组：血清透明质酸（HA）水平正常组和异常组。我们还将患者分为血清IV型胶原水平正常组和异常组。
正常组的总生存率和无复发生存率显著高于异常组。在透明质酸正常组中，血清白蛋白和凝血酶原时间显著高于异常组，年龄、丙型肝炎病毒抗体（HCV）-Ab阳性、Child-Pugh B级、肝硬化、15分钟吲哚菁绿滞留率（ICGR15）、IV型胶原水平和IV型胶原7s水平显著低于异常组。在IV型胶原正常组中，HCV-Ab阳性、肝硬化、ICGR15、HA水平和IV型胶原7s水平显著低于异常组，血清白蛋白水平显著高于异常组。多变量分析独立显示，血清IV型胶原对接受HCC肝切除术患者的总生存率有显著影响，血清HA对无复发生存率有显著影响。
术前检测血清透明质酸水平和IV型胶原水平对于HCC肝切除术至关重要，因为这些标志物与肝功能和预后显著相关。
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