Clinical Significance of Multiple Pulmonary Metastasectomy for Hepatocellular Carcinoma
Clinical Significance of Multiple Pulmonary Metastasectomy for Hepatocellular Carcinoma
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DOI：
10.1007/s00268-015-3213-3
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发表时间：
2016-02-01
影响因子：
2.6
通讯作者：
Kubo, Shoji
中科院分区：
文献类型：
--
作者：
Mizuguchi, Shinjiro;Nishiyama, Noritoshi;Kubo, Shoji
肺是肝细胞癌最常见的肝外转移部位。本研究的目的是评估肝细胞癌肺转移切除术的意义和远期疗效，特别是对于多发结节或反复肺复发的患者。我们回顾分析了1993-2013年间19例接受肝细胞癌肺转移切除术的患者。无住院死亡。19名患者包括14名男性。中位年龄61岁(20-76岁)。8名患者(42%)有单个肺转移灶，而4名患者(21%)有10个肺转移灶。肺转移瘤切除术后的中位随访期为23.1(6.3-230)个月。12名患者死亡，9名死因是肝细胞癌进展。肺转移瘤切除术后1、3、5、10年的总生存率分别为89%、48%、48%和21%。7例患者在初次肺转移瘤切除术后出现肺复发。7例患者中有5例再次接受转移切除，中位生存期为65个月，2年和3年生存率分别为100%和67%。4例10个肺结节患者的2年和3年生存率分别为75%和50%。手术切除是一种安全有效的治疗方法，适用于部分肝细胞癌肺转移患者，即使是多发结节患者也是如此。反复局部区域治疗肺部复发可能有助于提高这些患者的存活率。
The lung is the most common site of extrahepatic metastasis from hepatocellular carcinoma (HCC). The aim of this study was to evaluate the significance and long-term outcomes of pulmonary metastasectomy for HCC, especially in patients with multiple nodules or repeated pulmonary recurrence.We retrospectively analyzed 19 patients who underwent pulmonary metastasectomy for HCC at our institution from 1993 to 2013.No in-hospital mortality occurred. The 19 patients included 14 men. The median age was 61 (range 20-76) years. Eight patients (42 %) had single pulmonary metastatic lesions, whereas 4 (21 %) had > 10 lesions. Median follow-up after pulmonary metastasectomy was 23.1 (6.3-230) months. Twelve patients died, and the cause of death was HCC progression in nine. The 1-, 3-, 5-, and 10-year overall survival rates after pulmonary metastasectomy were 89, 48, 48, and 21 %, respectively. Seven patients developed pulmonary recurrence after initial pulmonary metastasectomy. Five of the seven underwent repeat metastasectomy, with a median survival time of 65 months, and 2- and 3-year survival rates of 100 and 67 %, respectively. The 2- and 3-year survival rates in the four patients with > 10 pulmonary nodules were 75 and 50 %, respectively.Surgical resection is a safe and effective treatment in selected patients with pulmonary metastasis from HCC, even in those with multiple nodules. Repeated locoregional therapy for lung recurrence might help to improve survival in these patients.