Lee N H, Chau G Y, Lui W Y, King K L, Tsay S H, Wu C W
Department of Surgery, Veterans General Hospital Taipei and College of Medicine, National Yang-Ming University, Taiwan.
Br J Surg. 1998 Dec;85(12):1654-7. doi: 10.1046/j.1365-2168.1998.00918.x.
Hepatocellular carcinoma (HCC) over 10 cm in diameter at the time of diagnosis continues to account for a number of patients undergoing hepatic resection. This study evaluated the clinicopathological features and outcome following surgery for large HCC.
Forty patients with a large HCC (greater than 10 cm) (group 1) resected between 1991 and 1996 were studied retrospectively. They were compared with 245 patients who had smaller HCCs (10 cm or less) (group 2).
No patient in group 1 had hepatitis C infection compared with 22.9 per cent in group 2 (P=0.001). Patients in group 1 were significantly younger, had higher alpha-fetoprotein levels (16750 versus 1864 ng/ml; P < 0.001), better liver function, a higher incidence of multiple tumours (27 of 40 versus 42.0 per cent; P=0.003) and venous invasion (35 of 40 versus 52.2 per cent; P < 0.001), and underwent more major resections (37 of 40 versus 26.5 per cent; P < 0.001) than those in group 2. Morbidity and mortality rates and hospital stay were comparable in the two groups. For group 1, the 1-, 3- and 5-year disease-free survival rates were 42, 30 and 28 per cent respectively. Multiple tumours, venous invasion and impaired liver function were factors associated with recurrence.
Large HCC had specific clinicopathological features. In selected patients, resection is safe and offers the chance of long-term disease-free survival.
诊断时直径超过10 cm的肝细胞癌（HCC）患者仍占接受肝切除手术患者的一定比例。本研究评估了大型HCC手术后的临床病理特征及预后。
回顾性研究了1991年至1996年间切除的40例大型HCC患者（第1组）。将他们与245例较小HCC患者（10 cm或更小）（第2组）进行比较。
第1组中无患者感染丙型肝炎，而第2组中这一比例为22.9%（P = 0.001）。第1组患者明显更年轻，甲胎蛋白水平更高（16750对1864 ng/ml；P < 0.001），肝功能更好，多肿瘤发生率更高（40例中有27例对42.0%；P = 0.003），静脉侵犯发生率更高（40例中有35例对52.2%；P < 0.001），并且与第2组相比，接受更多的大手术（40例中有37例对26.5%；P < 0.001）。两组的发病率、死亡率和住院时间相当。对于第1组，1年、3年和5年无病生存率分别为42%、30%和28%。多肿瘤、静脉侵犯和肝功能受损是与复发相关的因素。
大型HCC具有特定的临床病理特征。在经过选择的患者中，手术切除是安全的，并提供了长期无病生存的机会。
