An analysis of 412 cases of hepatocellular carcinoma at a western center
An analysis of 412 cases of hepatocellular carcinoma at a western center
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DOI：
10.1097/00000658-199906000-00005
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发表时间：
1999-06-01
影响因子：
9
通讯作者：
Blumgart, LH
中科院分区：
文献类型：
--
作者：
Fong, YM;Sun, RL;Blumgart, LH
目标 利用西方转诊中心的大型单一机构经验。作者研究了部分肝切除术作为肝细胞癌的治疗方法，并将治疗结果与临床参数（包括潜在肝硬化的病因）联系起来。方法在前瞻性数据库中确定了 1991 年 12 月至 1998 年 1 月期间就诊的 412 名患者。检查了有关手术过程、围手术期并发症和长期结局的数据。 结果 126 例患者没有潜在的肝硬化，在 286 例肝硬化患者中，119 例是乙型肝炎，39 例是丙型肝炎，36 例是乙型和丙型肝炎，43 例是酒精滥用，其余是其他原因。 243 名患者接受了手术探查，154 名患者接受了肝切除术。七人（4.5%）死于手术。一百四十三名患者接受了消融方法治疗。肝硬化患者的肿瘤较小，但可切除率较低。肝硬化的存在和肝硬化的病因均不会改变围手术期的发病率或死亡率。长期结果的最大决定因素是可切除性，病变大小、甲胎蛋白水平>2000 ng/ml和血管侵犯也是不良结果的决定因素。当对肿瘤大小进行分层分析时，肝硬化的存在是一个有害因素。肝硬化的原因并不影响长期结果。病灶切除10 cm的患者5年生存率为57%。结论肝部分切除术是治疗肝细胞癌安全、有效、具有潜在治愈性的方法。肝硬化的存在并不影响手术死亡率，但确实影响长期生存率。肝硬化的原因不影响结果。作为小肝细胞癌的治疗，部分肝切除术产生与移植相似的结果。对于不适合移植的大肿瘤患者，切除可使三分之一的患者长期生存。
Objective Using a large single-institution experience at a Western referral center. the authors examine partial hepatectomy as treatment of hepatocellular carcinoma and relate treatment outcomes to clinical parameters, including the etiology of underlying cirrhosis.Methods Four hundred and twelve patients seen between December 1991 and January 1998 were identified in a prospective database. Data about the surgical procedure, perioperative complications, and long-term outcome were examined.Results One hundred twenty-six patients did not have underlying cirrhosis, Of the 286 patients with cirrhosis, 119 were the result of hepatitis B, 39 hepatitis C, 36 both B and C, 43 ethanol abuse, and the remainder other causes. Two hundred forty three patients underwent surgical exploration, and 154 patients underwent hepatic resection. Seven (4.5%) died from the surgery. One hundred forty-three patients were treated by ablative methods. Patients with cirrhosis had smaller tumors but nevertheless had a lower resectability rate. Neither the presence of cirrhosis nor the etiology of the cirrhosis altered the perioperative morbidity or mortality rate. The greatest determinant of long-term outcome was resectability, The size of the lesion, an alpha-fetoprotein level >2000 ng/ml, and vascular invasion were also determinants of poor outcome. The presence of cirrhosis was a detrimental factor when analysis was stratified for size of tumor. The cause of cirrhosis did not influence the long-term outcome. The 5-year survival rate was 57% for patients with resected lesions 10 cm,Conclusion Partial hepatectomy is safe, effective, and potentially curative therapy for hepatocellular carcinoma. The presence of cirrhosis did not affect the surgical mortality rate but did affect the long-term survival rate. The cause of cirrhosis did not influence outcome. As treatment for small hepatocellular carcinomas, partial hepatectomy produces results similar to those of transplantation. For patients with large tumors who are poor candidates for transplantation, resection results in long-term survival in one third of patients.