巨大肝细胞癌患者RO切除术的预后

Prognosis of patients with huge hepatocellular carcinoma after RO resection

目的探讨巨大肝细胞癌（HCC）肝切除手术的预后及影响因素。方法对青岛大学医学院附属医院1997年1月至2008年12月517例原发性HCC获RO切除患者的临床资料进行回顾性分析。结果517例中巨大HCC（≥10cm）患者69例，小HCC（〈10cm）患者448例。二者的5和10年生存（OS）率为分别24％、18％和49％、30％，中位OS分别为23．0个月和58．0个月（P〈0．001，logrank检验），中位无瘤生存（DFS）分别为15．3个月和34．8个月（P〈0．001）。巨大HCC患者的1年复发率显著高于〈10CITIHCC患者（24．3oA比44．9％，P=0．022）。复发患者中二组肝外复发者分别占16．0％和32．7％（p=0．004）。与〈10cmHCC组相比，巨大HCC患者较为年轻，血清AFP值〉400ug／L者、大肝切除（≥3段）者、切缘〈0．5cm者、区域淋巴结转移者较多，围手术期输血亦较多，巨大HCC组织学呈高分化者显著低于〈10cmHCC组（P〈0．05）。Cox回归分析显示伴有门静脉高压症和血管癌栓是影响巨大HCC患者OS和DFS的独立危险因素，术前未行肝动脉化疗栓塞（TACE）是影响DFS的独立危险因素。结论手术切除治疗巨大HCC安全可行。伴有门静脉高压症和血管癌栓是影响此类患者预后的独立危险因素，术前TACE治疗能改善术后的无瘤生存。

Objective To study the prognosis of patients with huge hepatocellular carcinoma （HCC） after R0 resection. Methods 517 patients with primary HCC who underwent R0 resection from January 1997 to December 2008 at the Affiliated Hospital of Medical Gollege Qingdao University were analyzed retrospectively. Results The 5 and 10 years overall survivals （OS） in patients with huge HCC （≥10 cm; n=69） and in patients with HCC 〈10 cm （n=448） were 24%, 18% and 49%, 30%, respectively. The median OS was 23.0 and 58.0 month （P〈0. 001, log rank test） and the median disease-free survivals （DFS） were 15.3 and 34.8 month （P〈0. 001） , respectively. The recurrence rate within the first year and the extrahepatic recurrence after resection in patients with huge HCC was significantly higher than in patients with HCC %10 cm （44.9~ vs. 24.3%, P=0. 022~ 32.7~ vs. 16.0%, P=0. 004）. Independent poor prognostic factors of OS and DFS for patients with huge HCC after R0 resection were portal hypertension and vascular invasion. Preoperative transcathe- ter arterial chemoembolization （TACE） was an independent prognostic factor for better DFS. Conclu- sions Surgical resection for huge HCC is safe and feasible. For huge HCC after resection, portal hyperten- sion and vascular invasion were poor prognostic factors. Preoperative TACE improved DFS after resection.