Ko S, Nakajima Y, Kanehiro H, Hisanaga M, Aomatsu Y, Kin T, Yagura K, Ohyama T, Nishio K, Ohashi K, Sho M, Yamada T, Nakano H
First Department of Surgery, Nara Medical University, Kashihara, Japan.
Ann Surg. 1996 Nov;224(5):591-5. doi: 10.1097/00000658-199611000-00001.
The aim of this study was to evaluate the correlation between the histologic status of accompanying chronic hepatitis and the recurrence rate of hepatocellular carcinoma (HCC) after hepatectomy by multivariate analysis.
Recent studies have suggested that a considerable number of intrahepatic recurrence of HCC after hepatectomy might be the results of metachronous multicentric hepatocarcinogenesis. The authors hypothesized that the incidence of recurrence due to metachronous multicentric hepatocarcinogenesis would depend on the histologic status of accompanying chronic viral liver disease, which is a main promoter of HCC.
One hundred ten patients with HCC who underwent curative resection were studied. Histologic status of accompanying chronic hepatitis was classified into the three categories: 1) normal liver or chronic persistent hepatitis (CPH, n = 13), 2) chronic aggressive hepatitis (CAH, n = 50), and 3) liver cirrhosis (LC, n = 47).
The Cox multivariate proportional hazard model showed that the accompanying chronic viral hepatitis status (p = 0.0133), extent of hepatectomy (p = 0.0078), and number of tumors (p = 0.0475) were significantly predictive variables for recurrence-free survival. By the log-rank test, recurrence-free survival rate in patients with CPH was significantly higher than those in patients with CAH (p = 0.0005) and LC (p = 0.0075). Patients with CAH had the lowest recurrence-free survival rate (vs. LC, p = 0.028).
The results of this study indicated the significant influence of histologic activity of hepatitis on recurrence of HCC. This might support the concept of significant contribution of multicentric hepatocarcinogenesis to recurrence of HCC after hepatectomy.
本研究旨在通过多因素分析评估伴发慢性肝炎的组织学状态与肝细胞癌（HCC）肝切除术后复发率之间的相关性。
近期研究表明，肝切除术后相当数量的HCC肝内复发可能是异时多中心肝癌发生的结果。作者推测，异时多中心肝癌发生导致的复发发生率将取决于伴发慢性病毒性肝病的组织学状态，而慢性病毒性肝病是HCC的主要促发因素。
对110例行根治性切除的HCC患者进行研究。将伴发慢性肝炎的组织学状态分为三类：1）正常肝脏或慢性持续性肝炎（CPH，n = 13），2）慢性活动性肝炎（CAH，n = 50），3）肝硬化（LC，n = 47）。
Cox多因素比例风险模型显示，伴发慢性病毒性肝炎状态（p = 0.0133）、肝切除范围（p = 0.0078）和肿瘤数量（p = 0.0475）是无复发生存的显著预测变量。通过对数秩检验，CPH患者的无复发生存率显著高于CAH患者（p = 0.0005）和LC患者（p = 0.0075）。CAH患者的无复发生存率最低（与LC相比，p = 0.028）。
本研究结果表明肝炎的组织学活性对HCC复发有显著影响。这可能支持多中心肝癌发生对肝切除术后HCC复发有重大贡献的概念。
