影响3 cm以下小肝癌患者术后生存因素的观察

Prognostic factors influencing postoperative survival in patients with ≤3 cm small hepatocellular carcinoma

目的总结小肝癌的手术治疗经验,探讨影响其术后生存率的临床、病理因素。方法回顾性分析1986年1月—2003年12月间手术切除并获得随访的105例小肝癌(≤3cm)的临床、病理资料,中位随访时间33个月。对有无结节性肝硬化、肝功能Child分级、术前血清AFP水平、肿瘤大小、有无肿瘤包膜、肿瘤分化程度(Edmondson分级)、有无门静脉癌栓、肿瘤是否多灶性(包括卫星灶)及手术方式等9项临床、病理参数与术后生存率及无瘤生存率的关系进行单因素及Cox模型多因素分析。结果截止2004年5月,手术后1、3、5年生存率分别为86.5%、70.3%、55.2%,无瘤生存率分别为78.0%、58.9%、45.6%。再次手术死亡1例。随访期内36例肝内复发,34例死亡。单因素及多因素分析均提示术前肝功能Child分级、肿瘤大小、门静脉癌栓及肿瘤多灶性是影响手术后生存率的预后因素,多因素分析显示肿瘤大小、门静脉癌栓及多灶性是影响手术后无瘤生存率的预后因素。结论距肿瘤1cm以上切缘的局部切除是治疗小肝癌的合理手术方式,手术后的肝内复发和转移及肝功能不良是导致小肝癌患者术后死亡的主要原因。

Objective To summarize the experience of surgical resection,and to analyze the prognostic factors that can influence the postoperative survival in patients with small hepatocellular carcinoma(small HCC) of ≤3 cm in diameter. Methods The clinicopathologic data of 105 cases with small HCC after resection between 1986 and 2003 were analyzed, all of which had been followed up for more than half a year (median time, 33 months). Nine clinicopathologic factors including preoperative α-fetoprotein (AFP) level, liver cirrhosis, Child-Pugh score, tumor size (>2 cm vs. ≤ 2 cm) and number (single vs. multiple), capsule formation, portal vein tumor thrombi (PVTT), Edmondson tumor grade and surgical method were analyzed through the way of Log-rank and Cox Regression tests. Results Postoperatively,the cumulative survival rate of 1、3 and 5-year were 86.5%、70.3% and 55.2% respectively, and the disease-free survival rate of 1、3 and 5-year were 78.0%、58.9% and 45.6% respectively. One patient died from esophagogastric variceal hemorrhage in 2 weeks after re-operation. Up to the time of following up, 36 had intrahepatic recurrence or metastases postoperatively. Thirty-four patients died, of which, 4 died from variceal hemorrhage, 1 from liver failure, 1 died of pneumonia and 2 from distant metastases, while the others died from intrahepatic recurrences or metastases. Kaplan-Meier and multivariate Cox Regression tests indicated that poor Child-Pugh score, tumor more than 2 cm in diameter, PVTT and multiple lesions (including satellitic lesions) were adverse factors affecting postoperative survival. Multivariate Cox Regression tests indicated that tumor size, PVTT and multiple lesions were the factors affecting postoperative disease-free survival. Conclusions Limited hepatectomy with a margin no less than 1 cm is an appropriate surgical approach. Adverse preoperative Child-Pugh score and postoperative intrahepatic recurrences are main factors leading to the death of patients with small HCC.