摘要
目的比较肝硬化患者和非肝硬化患者的单个小肝细胞癌（长径≤5cm）手术切除疗效，探讨肝硬化对单个小肝细胞癌切除术后复发和患者长期生存的影响。方法采用回顾性研究方法，将2001年4月至2009年10月在我院肝脏外科中心接受肝切除术的单个小肝细胞癌患者共256例分为非肝硬化组（44例）和肝硬化组（212例），比较两组患者的无瘤生存率和总体生存率。男性227例，女性29例；年龄14～79岁，中位年龄49岁。224例（87．5％）患者合并乙型肝炎，241例（94．1％）患者术前肝功能为ChildA级。采用单因素和多因素分析探讨单个小肝细胞癌患者肝切除术后的预后因素。结果非肝硬化组患者的1、3、5年无瘤生存率和总体生存率分别为93．0％、85．3％、68．5％和100％、92．5％、92．5％，肝硬化组患者的1、3、5年无瘤生存率和总体生存率分别为81．1％、58．6％、45．0％和93．8％、78．7％、67．8％。非肝硬化组患者的无瘤生存率和总体生存率优于肝硬化组（χ^2=8．756，P=0．003；χ^2=8．603，P=0．003）。血管侵犯、肿瘤中低分化、无肿瘤包膜和肝硬化是影响单个小肝细胞癌患者肝切除术后复发的独立危险因素，亦是影响患者术后长期生存的独立危险因素。结论除血管侵犯、肿瘤中低分化、无肿瘤包膜等肿瘤生物学因素外，肝硬化亦是影响单个小肝细胞癌切除术后患者长期生存的重要不良预后因素。肝硬化患者肝切除术后的长期疗效劣于非肝硬化患者。
Objectives To compare the outcomes after liver resection for a single small hepatocellular carcinoma （HCC） （~〈5 cm） between non-cirrhotic patients and cirrhotic patients, and to explore the influence of liver cirrhosis on recurrence and overall survival after liver resection in patients with a single small HCC. Methods A consecutive series of 256 patients with a single small HCC undergoing liver resection from April 2001 to October 2009 was retrospectively reviewed. Among the 256 patients, 227 patients were male, and 29 were female. The medium age was 49 years （ ranged, 14-79 years ） ; 224 （87.5%） patients were positive for hepatitis B surface antigen, 241 （94.1%） patients were with preoperative liver function of Child-Pugh grade A. The entire cohort were divided into non-cirrhosis group （n = 44） and cirrhosis group （n = 212）. Univariate analysis and then multivariate analysis were performed to determine the prognostic factors of recurrence and overall survival after liver resection for all patients. Results The 1-, 3-, 5-year recurrence-free survival rates after liver resection were 93.0% , 85.3% , and 68.5%, respectively, in non-cirrhosis group, while 81.1%, 58.6%, and 45.0%, respectively, in cirrhosis group. The 1-, 3-, 5-year overall survival rates after liver resection were 100% , 92. 5% , and 92. 5% , respectively, in non-cirrhosis group, while 93.8% , 78.7% , and 67.8% , respectively, in cirrhosis group. Both the recurrence-free survival and overall survival of non-cirrhosis group were significantly better than those of cirrhosis group （ χ^2 = 8. 756, P = 0. 003 ; χ^2 = 8. 603, P = 0. 003 ）.Cirrhosis, absence of tumor capsule, presence of mierovascular invasion and moderate/poor tumor differentiation were the independent adverse prognostic factors for recurrence-free survival and overall survival in patients with a single small HCC after liver resection. Conclusions Cirrhosis is an important adverse prognostic factor for long-term survival in patients with a single small HCC after liver resection. Liver resection resulted in much worse survival for cirrhotic patients compared to non-cirrhotic patients.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2012年第10期865-869,共5页
Chinese Journal of Surgery
基金
基金项目：新世纪人才支持计划基金资助项目（NCET-04-0701）
国家自然科学基金资助项目（81172293,30972901）
关键词
癌
肝细胞
肝肿瘤
肝硬化
肝切除术
肿瘤复发
局部
Carcinoma, hepatocellular
Liver neoplasms
Liver cirrhosis
Hepatectomy
Neoplasm recurrence, local
