Tung W Y, Chau G Y, Loong C C, Wu J C, Tsay S H, King K L, Huang S M, Chiu J H, Wu C W, Lui W Y
Department of Surgery, Veterans General Hospital-Taipei and School of Medicine, National Yang-Ming University, Taiwan, Republic of China.
Eur J Surg Oncol. 1996 Oct;22(5):516-20. doi: 10.1016/s0748-7983(96)93056-5.
Primary hepatocellular carcinoma (HCC) extending to the adjacent organ(s) is sometimes encountered in patients with large, peripherally located tumours. Over a 4-year period, a total of 151 patients received curative resection of HCC at the Surgical Department of Veterans General Hospital-Taipei, Taiwan. Of these patients, 21 underwent hepatic resection combined with en-bloc resection of the adjacent organ(s) because tumour extension was found during operation. Subsequent histological examination of the resected specimens found evidence of HCC invasion into the resected adjacent organ(s) in only nine patients (group I), and the remaining 12 patients showed no evidence of extrahepatic HCC invasion (group II). Twenty-seven HCC patients with clinico-pathologically matched tumours but without extrahepatic extension were selected as controls (group III). One patient in group I died of hepatic failure after the operation. The morbidity rate was 48% in group I and group II patients, and 30% in group III patients. The difference was not statistically significant. On evaluating the clinico-pathological factors, including DNA ploidy status of the tumours, there were no significant differences between tumours with and without extrahepatic invasion. Patients with locally invasive HCC (group I) had disease-free and overall survival rates comparable with those of the patients without local tumour invasion (group II and III). We conclude that HCC with invasion to the adjacent organ(s) does not seem to be directly related to the 'aggressiveness' of the tumour, and extrahepatic infiltration of the tumour does not preclude a chance of cure. Our results underscore the need for en-bloc resection as treatment of choice for these patients.
原发性肝细胞癌（HCC）侵犯至邻近器官的情况有时会在患有大型周边型肿瘤的患者中出现。在4年期间，共有151例患者在台湾台北荣民总医院外科接受了HCC根治性切除术。在这些患者中，21例因术中发现肿瘤侵犯而接受了肝切除联合邻近器官整块切除术。随后对切除标本进行的组织学检查发现，仅9例患者（第一组）有HCC侵犯至切除的邻近器官的证据，其余12例患者无肝外HCC侵犯的证据（第二组）。选择27例临床病理特征匹配但无肝外侵犯的HCC患者作为对照组（第三组）。第一组中有1例患者术后死于肝衰竭。第一组和第二组患者的发病率为48%，第三组患者为30%。差异无统计学意义。在评估包括肿瘤DNA倍体状态在内的临床病理因素时，有肝外侵犯和无肝外侵犯的肿瘤之间无显著差异。局部侵犯性HCC患者（第一组）的无病生存率和总生存率与无局部肿瘤侵犯的患者（第二组和第三组）相当。我们得出结论，侵犯至邻近器官的HCC似乎与肿瘤的“侵袭性”无直接关系，肿瘤的肝外浸润并不排除治愈机会。我们的结果强调了整块切除作为这些患者首选治疗方法的必要性。
