Yamanaka N, Tanaka T, Tanaka W, Yamanaka J, Yasui C, Kuroda N, Takada M, Okamoto E
First Department of Surgery, Hyogo College of Medicine, Mukogawa-cho, Nishinomiya, Japan.
Cancer. 1997 Apr 15;79(8):1509-15. doi: 10.1002/(sici)1097-0142(19970415)79:8<1509::aid-cncr10>3.0.co;2-1.
This study investigated the relationship between clinicopathologic features and various viral serologies in patients who underwent hepatectomy in the treatment of hepatocellular carcinoma (HCC).
Two hundred two patients were allocated to four groups, according to their positivity or negativity for hepatitis B surface antigen (HBsAg) and hepatitis C virus antibody (HCVAb): Group I (HBsAg[-], HCVAb[+], n = 151), Group II (HBsAg[+], HCVAb[-], n = 27), Group III (HBsAg[-], HCVAb[-], n = 20), or Group IV (HBsAg[+], HCVAb[-], n = 4). The mean age of the HBsAg positive patients (Groups II and IV) was 10 years younger than that of the HBsAg negative patients (Groups I and III).
The male-to-female ratio was higher in HCVAb negative groups (II and III). The HCVAb positive groups (I and IV) had a significantly poorer hepatic reserve and smaller resections than the HCVAb negative groups. Because the tumors were more advanced (as determined by TNM staging) in Group II, the 3-year crude and disease free survival rates were lower in Group II than in Group I. However, HCVAb negative groups (II and III), when compared at 5 years with the limited subsets of patients who had tumors at earlier stages or a curative resection, had significantly better crude and disease free 5-year survival rates than the HCVAb positive group (I).
Clinicopathologic features differ from one another in accordance with the viral seromarkers in HCC patients. Significantly better crude and disease free survival after complete resection were promising results for patients with non-HCV-related HCC. By comparison, for patients with HCV-related HCC, the risk of intrahepatic recurrences never subsided even in later years after complete resection. Therefore, posthepatectomy follow-up management should be individualized depending on the viral serologic status of HCC patients.
本研究调查了接受肝切除术治疗肝细胞癌（HCC）患者的临床病理特征与各种病毒血清学之间的关系。
根据乙肝表面抗原（HBsAg）和丙肝病毒抗体（HCVAb）的阳性或阴性，将202例患者分为四组：第一组（HBsAg[-]，HCVAb[+]，n = 151），第二组（HBsAg[+]，HCVAb[-]，n = 27），第三组（HBsAg[-]，HCVAb[-]，n = 二十），或第四组（HBsAg[+]，HCVAb[-]，n = 4）。HBsAg阳性患者（第二组和第四组）的平均年龄比HBsAg阴性患者（第一组和第三组）小10岁。
HCVAb阴性组（第二组和第三组）的男女比例更高。HCVAb阳性组（第一组和第四组）的肝脏储备明显比HCVAb阴性组差，切除范围也更小。由于第二组的肿瘤分期更晚（根据TNM分期确定），第二组的3年粗生存率和无病生存率低于第一组。然而，HCVAb阴性组（第二组和第三组）在5年时与肿瘤处于早期或接受根治性切除的有限患者亚组相比，其5年粗生存率和无病生存率明显高于HCVAb阳性组（第一组）。
HCC患者的临床病理特征因病毒血清标志物而异。对于非HCV相关HCC患者，完全切除后粗生存率和无病生存率显著提高是令人鼓舞的结果。相比之下，对于HCV相关HCC患者，即使在完全切除后的晚年肝内复发风险也从未消退。因此，肝切除术后的随访管理应根据HCC患者的病毒血清学状态进行个体化。
