Nagashima I, Hamada C, Naruse K, Osada T, Nagao T, Kawano N, Muto T
First Department of Surgery, University of Tokyo, Japan.
Surgery. 1996 Jan;119(1):40-5. doi: 10.1016/s0039-6060(96)80211-x.
Surgical resection for hepatocellular carcinoma (HCC) can be curative in selected patients, particularly in those with a solitary small HCC (s-sHCC; 2 cm or less in diameter). However, even these patients often have a risk of tumor recurrence or death from underlying liver dysfunction. Therefore it is important to determine which clinicopathologic features are related to the long-term prognosis after resection of s-sHCC.
Fifty patients with s-sHCC underwent partial hepatectomy at our department between 1977 and 1992. Six (12%) died of liver failure in hospital after operation. Eight clinicopathologic features were examined in the remaining 44 patients with regard to their long-term prognosis by use of univariate and multivariate analyses.
The 1-, 3-, and 5-year survival rates were 90%, 75%, and 53%, respectively. The corresponding disease-free survival rates were 80%, 53%, and 30%, respectively. None of the following parameters was significantly related to survival rate or disease-free survival rate: presence of vascular invasion or capsular formation, the distance of free surgical margin (1 cm or more or not), serum alpha-fetoprotein level, positive hepatitis B surface antigen, and preoperative transarterial embolization. Complicated liver function was the only significant factor related to survival rate and disease-free survival rate.
A good hepatic reserve is an important factor in treating patients with s-sHCC by surgical resection, even for a long-term prognosis. Liver transplantation should be considered for patients with severe cirrhosis and s-sHCC, even though a curative resection might be possible.
肝细胞癌（HCC）的手术切除对部分患者可达到治愈效果，尤其是那些患有孤立性小肝癌（s-sHCC；直径2cm或更小）的患者。然而，即使是这些患者也常有肿瘤复发或因潜在肝功能障碍而死亡的风险。因此，确定哪些临床病理特征与s-sHCC切除术后的长期预后相关非常重要。
1977年至1992年间，50例s-sHCC患者在我科接受了肝部分切除术。6例（12%）术后在医院死于肝功能衰竭。对其余44例患者的8项临床病理特征进行单因素和多因素分析，以评估其长期预后。
1年、3年和5年生存率分别为90%、75%和53%。相应的无病生存率分别为80%、53%和30%。以下参数均与生存率或无病生存率无显著相关性：血管侵犯或包膜形成、手术切缘宽度（是否≥1cm）、血清甲胎蛋白水平、乙肝表面抗原阳性以及术前经动脉栓塞。肝功能复杂程度是与生存率和无病生存率相关的唯一显著因素。
良好的肝脏储备是手术切除治疗s-sHCC患者的重要因素，即使对于长期预后也是如此。对于患有严重肝硬化和s-sHCC的患者，即使可能实现根治性切除，也应考虑肝移植。
