纤维板层型肝癌的治疗及预后分析

Postoperative prognostic factors for fibrolamellar hepatocellular carcinoma

目的总结分析纤维板层型肝癌的治疗及临床预后特点。方法回顾分析1991年6月至2005年12月间共26例纤维板层型肝癌患者的临床病例资料。结果全部病例获得随访，随访截至2006年10月，术后3年、5年生存率为43％、32％；术后3年、5年无瘤生存率为26％，19％，全组患者中位生存时间35．6个月。Kaplan-Meier生存分析显示：肿瘤大血管浸润、淋巴结转移、伴有肝硬化、肿瘤多发和术前肝功能状态是影响患者生存时间的危险因素；肿瘤大血管浸润、淋巴结转移、术前肝功能状态和肿瘤多发是影响患者无瘤生存时间的危险因素。结论术前肝功能较差、伴有肝硬化、肿瘤多发、有大血管侵犯和（或）淋巴结转移的纤维板层型肝癌患者预后较差；肿瘤大血管浸润、淋巴结转移、术前肝功能较差和肿瘤多发是纤维板层型肝癌术后转移复发的危险因素。

Objective To analyze the therapeutic strategies and prognostic factors that influence clinical outcome of fibrolamellar hepatoeellular carcinoma （FLHCC）. Methods Twenty six patients with FLHCC undergoing liver resection between Jun 1991 and Dec 2005 were retrospectively analyzed. Results All postoperative patients were followed up until Oct 2006. The 3- and 5-year overall survival rate was 43% and 32%, respectively, and the 3- and 5-year disease free survival rate was 26% and 19% , respectively. Median survival was 35.6 months. Kaplan-Meier analysis showed that five variables including large vessel invasion, lymphatic metastasis, liver cirrhosis, multiple tumor occurrence and preoperative liver function were related to overall survival. Four variables including large vessel invasion, lymphatic metastasis, multiple tumor occurrence and preoperative liver function were related to disease free survival. Conculsions Patients with poor preoperative liver function, liver cirrhosis, multiple tumor loci, large vessel invasion and/ or lymph node metastasis have poor prognosis. Large vessel invasion, poor preoperative liver function, lymphatic metastasis and multiple tumor foci are hazard factors of FLHCC foreboding metastasis and postoperative recurrence.