原发性肝癌的分期、根治切除标准及预后指标

Tumor staging scheme,radical resection criterion and prognostic index of primary liver cancer

论述了原发性肝癌的分期方案、根治切除标准及预后指标三者的研究进展及相互间的关系。肝癌临床分期尚没有统一的实用方案 ,TNM分期随着不断修订 ,得到了一定的认可和推广 ,我国 1999年修订的方案大致与TNM分期相对应。目前也没有通用的肝癌切除根治标准 ,临床上通常分为根治性切除与姑息性切除两类 ,比较笼统 ;在细胞病理学的基础上可分为病理根治性、临床根治性和姑息性切除三类。多因素分析表明 ,影响肝癌总体预后的因素主要是肿瘤分期、病理类型、治疗措施、肿瘤生物学特性以及并发症 ,而影响手术后复发和转移的因素主要是手术切除程度和病理特征。临床分期是选择治疗方案的基础 ,预后分析则是验证肝癌的分期和根治切除标准是否合理的手段 ;肝癌的准确分期。

Progress of tumor staging scheme, radical resection criterion and prognostic index of primary liver cancer and their relationships were reviewed. There is still not a consolidated and practicable tumor staging scheme. TNM staging becomes popular and acceptable after several times revisions. The Chinese staging scheme revised in 1999 approximately corresponds to TNM staging. Neither there is a universal radical resection criterion of liver cancer. Generally it is classified into 2 groups, curative and palliative resection. Based on histopathology,it could be classified into 3 groups, pathologically and clinically curative resection and palliative resection. Multivariate analysis shows that tumor stages, pathologic types, treatment modalities, tumor biologic characteristics and complications are related to prognosis. Resection patterns and pathologic characteristics are the determining factors related to the postoperative recurrence and metastasis rates. Tumor staging scheme is the basis to select treatment modalities and prognostic analysis could verify their rationality, whose improvement depends on the development of molecular biotechnology.