Surgical intervention for patients with stage IV-A hepatocellular carcinoma without lymph node metastasis - Proposal as a standard therapy
Surgical intervention for patients with stage IV-A hepatocellular carcinoma without lymph node metastasis - Proposal as a standard therapy
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DOI：
10.1097/00000658-199803000-00016
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发表时间：
1998-03-01
影响因子：
9
通讯作者：
Yamamoto, M
中科院分区：
文献类型：
--
作者：
Ikai, I;Yamaoka, Y;Yamamoto, M
本研究的目的是评价手术治疗无淋巴结转移的IV-A期肝细胞癌的疗效。为了提高存活率，已经开始了外科治疗。方法对150例肝切除患者的预后进行分析。生存分析是通过将IV-A期肝癌患者分成两组-那些有门静脉或肝静脉主要分支受累的和那些没有门静脉主支或肝静脉受累的。结果肿瘤累及多个肺叶且无血管侵犯者的5年生存率(20%)明显高于有血管侵犯者(8%)(P<；0.01)。肝静脉癌栓的存活率(10%)好于下腔静脉癌栓的存活率(0%)，但门静脉一支癌栓的存活率(11%)与门静脉主干癌栓的存活率(4%)无显著差异。手术死亡率由前6年的14.3%降至5年后的1.4%。结论对IV-A期肝癌患者进行手术治疗可提高部分患者的生存率。我们建议手术治疗是晚期肝细胞癌患者的有效治疗手段。
ObjectiveThe aim of this study was to evaluate the effects of surgical treatments for patients with stage IV-A hepatocellular carcinoma (HCC) without lymph node metastasis.Summary Background DataNonsurgical therapy for highly advanced HCC patients has yielded poor long-term survival. Surgical intervention has been initiated in an effort to improve survival.MethodsThe outcome of 150 patients who underwent hepatic resection was studied. Survival analysis was made by stratifying stage IV-A HCC patients into two groups-those with and those without involvement of a major branch of the portal or hepatic veins. Those with involvement were further divided into subgroups according to major vascular invasions.ResultsPatients who had multiple tumors in more than one lobe without vascular invasion had a significantly better 5-year survival rate (20%) than those with vascular invasion (8%) (p < 0.01). The survival rate of patients with hepatic vein tumor thrombi (10%) was better than the rate for those with tumor thrombi in the inferior vena cava (0%), in whom no patients survived more than 2 years, although the survival rate for those with portal vein tumor thrombi in the first branch (11%) was no different from the rate for that in the portal trunk (4%). The operative mortality decreased from 14.3% in the first 6 years to 1.4% in the following 5 years.ConclusionsSurgical intervention for stage IV-A HCC patients brought longer survival rates for some patients. We recommend surgical intervention as an effective therapeutic modality for patients with advanced HCC.