肝细胞癌术后复发的临床病理

Clinicopathologic risk factors and prognostic evaluation in hepatocellular carcinoma recurrence after surgery

目的探讨影响人肝细胞癌术后复发和预后的临床病理危险因素．方法应用单因素或多因素显著性检验及Ｗｉｌｃｏｘｏｎｃｏｘ回归检验，对１５６例治疗性切除人肝细胞癌病例进行回顾性临床病理学（包括性别、瘤数、瘤大小、肝包膜浸润及门静脉累及等）分析．结果肝细胞癌１５６例中，首发癌７３例，复发癌８３例，术后复发率５３２％，其中亚临床可再切除复发肝癌６５例，再切除率为７８３％（６５／８３）．全组病例１、２、３、４、５年术后生存率分别为６８４％，５７３％，４６７％，３１５％和２８６％．肝癌术后复发相关的临床病理因素主要是：男性，多个，瘤体大（直径＞５ｃｍ），包膜浸润和门静脉累及等，术后复发率高，无瘤活存时间短（Ｐ＜００５）．结论肝细胞癌术后复发的危险因素为男性，多个（＞２个），体积大（直径＞５ｃｍ），包膜癌浸润和肝门血管癌栓形成等．肝细胞癌术后复发主要为单中心性，肝右前叶为术后复发多发肝段．

AIM To analyze the clinicopathologic risk factors in hepatocellular carcinoma recurrence after surgery. METHODS Significance test (χ 2 and Student t test) of the single and multiple factors, and Wilcoxon Cox tropic examination were used, a retrospective clinicopathologic analysis was made in 156 cases of hepatocellular carcinoma after hepatectomy. RESULTS Of the 156 cases, 68 4%, 57 3%, 46 7%, 31 5% and 28 6% had 1, 2, 3, 4 and 5 postoperative tumor free years respectively with a total recurrence rate of 53 2% (83/156). In the 83 recurrent cases, 65 were of intrahepatic sabclinical type, with a re resection rate of 78 3% (65/83). The relevant factors involved in recurrence were: males, tumor number and size, capsule infiltration, portal veins involvement, etc. Those factors obviously influenced the prognosis of the patients with postoperative hepatocellular carcinoma ( P <0 05). 63 1% tumor nodes (41/65) of recurrent liver cancinomas were located at the ipsilateral segment of the primary ones. CONCLUSION Males, tumor number and size, capsule infiltration and portal veins involvement are the factors for postoperative hepatocellular carcinoma recurrence after surgery. The recurrence is mainly unicentral. Right front lobe is the liver segment with a high recurrence rate.