Yamamoto J, Kosuge T, Takayama T, Shimada K, Yamasaki S, Ozaki H, Yamaguchi N, Makuuchi M
Department of Surgery, National Cancer Centre Hospital, Tokyo, Japan.
Br J Surg. 1996 Sep;83(9):1219-22.
A total of 386 patients who underwent complete resection of hepatocellular carcinoma over an 8-year period were assessed retrospectively for tumour recurrence. Some 219 (56.7 per cent) of the patients developed recurrence. Patients with a greater degree of cirrhosis showed a longer interval to recurrence; the median (range) interval until recurrence was 7.9 (1.8-84.2) months in patients with a normal liver, 13.4 (2.0-79.5) months in those with chronic hepatitis and 16.7 (1.5-73.1) months in those with cirrhosis. Intrahepatic recurrence was observed more frequently in either the same (26.4 per cent) or the adjacent (24.8 per cent) Healey segment than in the lobe contralateral to the primary tumour (17.8 per cent). The presence of portal venous invasion and/or intrahepatic metastasis, underlying liver cirrhosis and perioperative blood transfusion were determined to be independent predictors of recurrence by multivariate analysis. Because intrahepatic spread of hepatocellular carcinoma occurs in a segment-by-segment manner, surgeons should use an anatomically wide resection within the hepatic functional reserve.
对8年间接受肝细胞癌根治性切除术的386例患者进行回顾性肿瘤复发评估。约219例（56.7%）患者出现复发。肝硬化程度较重的患者复发间隔时间较长；肝脏正常的患者复发的中位（范围）间隔时间为7.9（1.8 - 84.2）个月，慢性肝炎患者为13.4（2.0 - 79.5）个月，肝硬化患者为16.7（1.5 - 73.1）个月。肝内复发在同一（26.4%）或相邻（24.8%）的希利段比在原发肿瘤对侧叶（17.8%）更常见。多因素分析确定门静脉侵犯和/或肝内转移、潜在肝硬化及围手术期输血是复发的独立预测因素。由于肝细胞癌肝内播散呈节段性发生，外科医生应在肝功能储备范围内进行解剖学上广泛的切除。
