Tang Z Y, Uy Y Q, Zhou X D, Ma Z C, Lu J Z, Lin Z Y, Liu K D, Ye S L, Yang B H, Wang H W
Liver Cancer Institute, Shanghai Medical University, People's Republic of China.
World J Surg. 1995 Nov-Dec;19(6):784-9. doi: 10.1007/BF00299771.
The poor prognosis of hepatocellular carcinoma (HCC) was partly a result of the majority of unresectable HCCs in clinical patients. Fortunately, with the progress of regional cancer therapies and multimodality treatment, some of the localized unresectable HCCs were converted to resectable ones. During the period 1960-1994, 72 of the 663 patients with surgically verified unresectable HCCs have been converted to resectable. Successful cytoreduction with median diameter reduced from 10 cm to 5 cm was mainly a result of the triple or double combination treatment with hepatic artery ligation, hepatic artery cannulation with infusion, radioimmunotherapy, and fractionated regional radiotherapy. The interval between the first operation and the sequential resection was 5 months. The operative mortality was 1.4% for sequential resection, and the 5-year survival was 62.1%. Analysis of factor influencing sequential resection rate revealed HCCs that were single nodule, well encapsulated, situated at right lobe or hepatic hilum, associated with micronodular cirrhosis, and treated with triple or double combination modalities had higher sequential resection rate as compared to their counterparts. Analysis of factors influencing survival after sequential resection revealed that HCCs with a solitary tumor confined in one lobe, without tumor embolus, and without residual cancer in specimen of sequential resection, had longer survival. It is suggested that localized unresectable, solitary, well encapsulated, right lobe or hilar HCC, associated with micronodular cirrhosis, will be good candidates for cytoreduction and sequential resection; and HCCs with unilateral involvement, without tumor embolus, and with complete necrosis of tumor after multimodality treatment favored better prognosis.
肝细胞癌（HCC）预后较差，部分原因是临床患者中大多数HCC无法切除。幸运的是，随着区域癌症治疗和多模式治疗的进展，一些局限性不可切除的HCC转变为可切除的。在1960年至1994年期间，663例经手术证实不可切除的HCC患者中有72例转变为可切除。中位直径从10 cm缩小至5 cm的成功细胞减灭主要是肝动脉结扎、肝动脉插管灌注、放射免疫治疗和分次区域放疗三联或双联联合治疗的结果。首次手术与序贯切除之间的间隔为5个月。序贯切除的手术死亡率为1.4%，5年生存率为62.1%。对影响序贯切除率的因素分析显示，与其他情况相比，单结节、包膜完整、位于右叶或肝门、伴有小结节性肝硬化且接受三联或双联联合治疗的HCC序贯切除率更高。对序贯切除后生存影响因素的分析显示，肿瘤局限于一叶、无肿瘤栓子且序贯切除标本中无残留癌的HCC生存时间更长。提示局限性不可切除、孤立、包膜完整、右叶或肝门HCC，伴有小结节性肝硬化，将是细胞减灭和序贯切除的良好候选者；多模式治疗后单侧受累、无肿瘤栓子且肿瘤完全坏死的HCC预后较好。
