肝癌多模式治疗的远期疗效

Long┐termresultsofmultimodalitytreatmentinpatientswithprimarylivercancer

作者报道了过去３０年间收治的２３８８例经病理证实的原发性肝癌多模式治疗的远期疗效。手术切除（ｎ＝１６５０）后５年、１０年生存率分别为３９．３％、２９．２％，其中小肝癌（≤５ｃｍ，ｎ＝５６９）为６１．９％、４５．４％。液氮局部冷冻（ｎ＝１９１）后５年生存率为３７．９％，其中小肝癌（ｎ＝５６）为５３．１％。不能切除肝癌缩小后二期切除（ｎ＝７１）５年生存率为６６．０％。肝癌复发再切除（ｎ＝１４７）后５年生存率为３４．５％。全组生存５年以上２１４例，其中小肝癌１１３例（占５２．８％），生存１０年以上５７例。本结果表明，早期发现小肝癌、早期手术切除是可使患者获得长期生存，二期切除可能是提高不能切除肝癌疗效的重要途径，对根治性切除术后亚临床复发和转移的再手术能进一步提高疗效。

Thispaperreportthelong-termresultsofmultimodalitytreatmentin2388patientswithpathologicalyprovenprimarylivercancer(PLC)overthelastthreedecades.The5-and10-yearsur-vivalafterresectionofPLCwas39.3%and29.2%respectivelyforthewholeseries(n=1650),and61.9%and45.4%respectivelyforpatientswithsmalPLC(≤5cm,n=569).The5-yearsurvivalaf-tercryosurgerywas37.9%forthewholeseries(n=191),and53.1%forpatientswithsmalPLC(n=56).The5-yearsurvivalof71patientsreceivingsequentialresectionaftercytoreductiontherapywas66.0%.The5-yearsurvivalafterre-resectionforrecurrencetumor(n=147)was34.5%.214patientssurvivedmorethan5years;ofthese113patients(52.8%)weresmalPLC,and57patientssurvivedmorethan10rears.ItisconcludedthatearlydetectionandresectionofsmalPLCistheleadingap-proachtogetlong-termsurvivors,cytoreductionandsequentialresectionmightbeanimportantap-proachtoimprovingtheprognosisofpatientswithunresectablePLC,re-resectionforsubclinicalrecur-ranceandmetastasisafteraninitialcurativeresectionwasalsoimportanttoprolongsurvivalfurther.