Clinicopathological Features of Recurrence in Patients After 10-year Disease-free Survival Following Curative Hepatic Resection of Hepatocellular Carcinoma
Clinicopathological Features of Recurrence in Patients After 10-year Disease-free Survival Following Curative Hepatic Resection of Hepatocellular Carcinoma
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DOI：
10.1007/s00268-013-1902-3
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发表时间：
2013-04-01
影响因子：
2.6
通讯作者：
Kwon, A-Hon
中科院分区：
文献类型：
--
作者：
Kaibori, Masaki;Kubo, Shoji;Kwon, A-Hon
背景本研究旨在阐明肝细胞癌（HCC）切除术后长期疾病-费用生存的临床病理特征。方法本回顾性研究确定了1991年至2000年在五所大学医院接受根治性切除术的940例HCC患者。74例10年无复发生存的患者被确定并随访。结果复发组和非复发组16年生存率分别为68%和91%，20年生存率分别为34%和91%，P = 0.02。在10年无复发后，分别有5例（36%）和2例（3%）死亡。4名患者（29%）因复发进行了第二次切除术，第一次肝切除术后的平均生存期为15.3年。虽然无复发组中有3名患者（5%）发生了食管和/或胃静脉曲张，但复发组中有7名患者（50%）在10年内发生了静脉曲张（p < 0.0001）。在多变量分析中，术前和10年血小板计数被确定为一个有利的独立因素，维持无复发生存后，10年的无复发期后，根治性肝切除HCC.Conclusions肝癌复发可能会发生，即使经过10年的无复发期。肝癌切除术后的长期随访是重要的，应该是终身的。术前和10年血小板计数较高的患者更有可能在切除术后获得长期生存。与肝纤维化程度相关的低血小板计数是肝癌根治性切除术后复发和生存的危险因素。
Background The present study aimed to clarify the clinicopathologic features of long-term disease-fee survival after resection of hepatocellular carcinoma (HCC).Methods This retrospective study identified 940 patients who underwent curative resection of HCC between 1991 and 2000 at five university hospitals. Seventy-four patients with 10 years of recurrence-free survival were identified and followed up. They were divided into two groups, 60 recurrence-free and 14 with recurrence after a 10-year recurrence-free period.Results Overall survival rates of recurrence and non-recurrence groups were 68 and 91 % at 16 years, and 34 and 91 % at 20 years (p = 0.02), respectively. There were five (36 %), and two deaths (3 %), respectively, after 10 recurrence-free years. A second resection for recurrence was performed in four patients (29 %), and mean survival was 15.3 years after the first hepatectomy. Although three patients in the non-recurrence group (5 %) developed esophageal and/or gastric varices, seven patients in the recurrence group (50 %) developed varices during 10 years (p < 0.0001). In multivariate analysis, preoperative and 10-year platelet count was identified as a favorable independent factor for maintained recurrence-free survival after a 10-year recurrence-free period following curative hepatic resection of HCC.Conclusions Recurrence of HCC may occur even after a 10-year recurrence-free period. Long-term follow-up after resection of HCC is important, and should be life-long. Patients with higher preoperative and 10-year platelet counts are more likely to have long-term survival after resection. A low platelet count, related to the degree of liver fibrosis, is a risk factor for recurrence and survival of HCC after curative resection.