Implication of frequent local ablation therapy for intrahepatic recurrence in prolonged survival of patients with hepatocellular carcinoma undergoing hepatic resection - An analysis of 610 patients over 16 years old
Implication of frequent local ablation therapy for intrahepatic recurrence in prolonged survival of patients with hepatocellular carcinoma undergoing hepatic resection - An analysis of 610 patients over 16 years old
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DOI：
10.1097/01.sla.0000217921.28563.55
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发表时间：
2006-08-01
影响因子：
9
通讯作者：
Shimahara, Yasuyuki
中科院分区：
文献类型：
--
作者：
Taura, Kojiro;Ikai, Iwao;Shimahara, Yasuyuki
目的：通过比较队列在2个专属的时间框架，影响手术结果的肝细胞癌（HCC）患者的因素presented.Summary背景资料：据报道，肝癌患者接受肝切除术的生存结果近年来有所改善。然而，这些有利的结果的主要因素还没有得到充分的解释。方法：1985年1月至2000年12月，610例肝癌患者进行肝切除术作为一个主要的和治愈性切除。根据手术年份将其分为2组：1990年之前（n = 212;早期组）和1991年之后（n = 398;晚期组）。临床病理数据，组），I生存数据，复发类型，治疗肝内复发进行了比较2 groups.Results：临床病理数据几乎是相同的组之间除了年龄，失血量，手术时间。与早期组相比，We组的总生存率明显更好（5年时58.0% vs.39.1%，P < 0.0001）。相比之下，无病生存率保持不变（5年时27.8% vs. 26.2%，P = 0.2887）。最常见的复发类型是肝内复发，两组之间的复发率和复发类型没有差异。复发后5年生存率在晚期组中增加（21.8%对11.6%）。P = 0.0002）。按初始复发类型分层分析显示，晚期组仅在孤立性肝内复发中获得更好的生存率，而在多发性肝内或肝外复发中没有。仅在孤立性肝内复发的管理中观察到复发治疗方式的变化，其中经皮消融治疗更频繁地应用于新的消融技术。晚期组接受消融治疗的患者复发后生存率高于早期组。多变量分析表明，局部消融治疗的存在是一个独立的有利预后因素，只有在晚期group.Conclusions：在治疗性肝切除的HCC患者的结局取得了显着改善。肝内复发的经皮消融治疗被认为是改善复发后生存率和总生存率的主要因素。
Objective: By comparing cohorts in 2 exclusive time frames, the factors that affected the surgical outcomes of patients with hepatocellular carcinoma (HCC) are presented.Summary Background Data: Reportedly, survival results of patients with HCC who underwent hepatectomy have improved in recent years. However, the major factors contributing to these favorable outcomes have not been fully explained.Methods: Between January 1985 and December 2000, 610 patients with HCC underwent liver resections as a primary and curative resection. They were categorized into 2 groups according to the year in which the surgeries were performed: before 1990 (n = 212; early group); and after 1991 (n = 398; late group). Clinicopathologic data, roup), I survival data, type of recurrence, and treatment of intrahepatic recurrence were compared between the 2 groups.Results: Clinicopathologic data were almost identical between the groups except for age, blood loss, and duration of surgery. The overall survival rate was significantly better in the We group compared with the early group (58.0% vs. 39.1% at 5 years, P < 0.0001). By contrast, disease-free survival remained unchanged (27.8% vs. 26.2% at 5 years, P = 0.2887). The most common type of recurrence was intrahepatic relapse, and there was no difference in the rate and the type of recurrence between the 2 groups. The 5-year survival rate after recurrence was increased in the late group (21.8% vs. 11.6%. P = 0.0002). Stratified analysis by the type of initial recurrence revealed that better survival in the late group was achieved only in solitary intrahepatic recurrences, not in multiple intrahepatic or extrahepatic recurrences. Changes in modality of treatment of recurrence were observed only in the management of solitary intrahepatic recurrences, where percutaneous ablation therapies were more frequently applied with new ablation techniques. Patients that had undergone ablation therapies in the late group had better postrecurrent survival than those in the early group. Multivariate analysis showed that presence of local ablation therapies was an independent favorable prognostic factor only in the late group.Conclusions: Significant improvements in outcomes were achieved in patients with HCC who underwent curative liver resections. Percutaneous ablation therapy for intrahepatic recurrence was considered to be a major contributory factor for improving survival after recurrence, as well as for overall survival.