INCIDENCE AND FACTORS ASSOCIATED WITH INTRAHEPATIC RECURRENCE FOLLOWING RESECTION OF HEPATOCELLULAR-CARCINOMA
INCIDENCE AND FACTORS ASSOCIATED WITH INTRAHEPATIC RECURRENCE FOLLOWING RESECTION OF HEPATOCELLULAR-CARCINOMA
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DOI：
10.1016/0016-5085(93)90724-q
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发表时间：
1993-08-01
期刊：
影响因子：
29.4
通讯作者：
YUKAYA, H
中科院分区：
文献类型：
--
作者：
NAGASUE, N;UCHIDA, M;YUKAYA, H
背景：肝细胞癌切除后的远期生存率远不能令人满意，主要原因是肝内复发率较高。方法：对201例根治性肝切除患者的10年累计肝内复发率从7个临床因素和8个病理因素进行分析。结果：121例患者在随访期内发现IHR。1年、2年、3年、4年、5年和10年的国际卫生条例总发生率分别为22%、43%、62%、72%、75%和75%。年龄、性别、血清α-胎儿蛋白水平、乙肝病毒标志物和肝切除范围与IHR发生率无明显关系。术后以蒽环类药物为主的化疗有抑制IHR的趋势(P=0.0889)，而术前化疗栓塞术对IHR无影响。在整个观察过程中，出现肝硬变、卫星结节、静脉侵犯和无包膜形成与较高的复发率相关。手术切缘阳性(≤5 mm)也与较高的国际心率变化率相关。尽管不显著，但与低分化的肿瘤相比，高分化的肝癌复发率更高。肿瘤的大小和数目不影响IHR的发生率。结论：准确的患者选择和充足的肝脏储备是肝癌切除治疗的重要考虑因素。
Background:The long-term survival rate after liver resection of hepatocellular carcinoma (HCC) is far from satisfactory, mainly because of high intrahepatic recurrence (IHR) rates. This study was aimed to clarify clinicopathologic factors relevant to IHR after resection of HCC.Methods:The 10-year cumulative intrahepatic recurrence rates were analyzed in terms of seven clinical and eight pathological factors in 201 patients with curative hepatic resection.Results:IHR was found in 121 patients during the follow-up period. The overall IHR rates were 22% at 1 year, 43% at 2 years, 62% at 3 years, 72% at 4 years, 75% at 5 years, and 75% at 10 years. Age, sex, and serum α-fetoprotein level, hepatitis B virus markers, and extent of liver resection were not significantly related to the IHR rate. Postoperative chemotherapy mainly with anthracycline tended to suppress IHR (P = 0.0889), but preoperative chemoembolization did not affect IHR. The presence of cirrhosis, satellite nodules, and venous invasion and the absence of capsule formation were associated with higher recurrence rates throughout the observation. Positive surgical margin (≤5 mm) was also associated with a higher IHR rate. Although not significant, well-differentiated HCCs showed a higher recurrence rate in comparison with poorly differentiated tumors. Size and number of tumor did not influence the IHR rate.Conclusions:Accurate patient selection and adequate hepatic reserve are important considerations in the management of HCC by resection.