Arii S, Monden K, Niwano M, Furutani M, Mori A, Mizumoto M, Imamura M
Department of Surgery and Surgical Basic Science, Graduate School of Medicine, Kyoto University, 54 Kawara-Cho, Shogoin, Sakyo-Ku, Kyoto 606-01, Japan.
J Hepatobiliary Pancreat Surg. 1998;5(1):86-92. doi: 10.1007/pl00009956.
No consensus has been reached on the indications for and effectiveness of surgery for secondary intrahepatic hepatocellular carcinoma (HCC) and extrahepatic metastasis after macroscopically complete removal of primary HCC. Secondary intrahepatic HCCs, usually regarded as recurrence are classified into those arising as a result of multicentric carcinogenesis or intrahepatic metastases derived from the primary HCC. The present study was designed to evaluate the utility of surgical treatment in relation to the pathogenesis of the secondary HCC: classified as multicentric carcinogenesis (MC), intrahepatic metastasis (IM), and extrahepatic metastasis. Thirty patients underwent extirpation of secondary HCC: 22 patients had secondary HCCs in the remnant liver (MC group; n = 8; IM group, n = 14), 6 patients had extrahepatic metastases, and 2 patients had both intrahepatic and extrahepatic metastases. Survival rates after the re-resection in the 22 patients with the secondary intrahepatic HCCs were 94.7% at 1 year, and 50.2% at 3 years postoperatively, and the 8 patients with extrahepatic metastasis had survival rates of 62.5% at 1 year, 37.5% at 3 years, and at 5 years. The survival rates after re-resection in the MC group were 100% at 1 year and 80.0% at 3 years, whereas those in the IM group were 91.7% at 1 year, and 38.1% at 3 years. Surgery can be indicated not only in patients with localized intrahepatic secondary HCCs but also in those with extrahepatic metastasis. In particular, patients with secondary HCCs arising as a result of multicentric carcinogenesis are expected to have a good prognosis.
对于原发性肝癌肉眼完全切除术后继发性肝内肝细胞癌（HCC）及肝外转移的手术指征和疗效，目前尚未达成共识。继发性肝内HCC通常被视为复发，分为多中心癌变或原发性HCC肝内转移所致。本研究旨在评估手术治疗与继发性HCC发病机制（分为多中心癌变（MC）、肝内转移（IM）和肝外转移）的相关性。30例患者接受了继发性HCC切除术：22例患者在残余肝脏中有继发性HCC（MC组；n = 8；IM组，n = 14），6例患者有肝外转移，2例患者同时有肝内和肝外转移。22例继发性肝内HCC患者再次切除术后1年生存率为94.7%，术后3年生存率为50.2%，8例肝外转移患者1年生存率为62.5%，3年生存率为37.5%，5年生存率为[此处原文未给出5年生存率具体数据]。MC组再次切除术后1年生存率为100%，3年生存率为80.0%，而IM组1年生存率为91.7%，3年生存率为38.1%。手术不仅适用于局限性肝内继发性HCC患者，也适用于肝外转移患者。特别是多中心癌变所致继发性HCC患者预后有望良好。
