Early and late recurrence after liver resection for hepatocellular carcinoma - Prognostic and therapeutic implications
Early and late recurrence after liver resection for hepatocellular carcinoma - Prognostic and therapeutic implications
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DOI：
10.1097/01.sla.0000197706.21803.a1
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发表时间：
2006-02-01
影响因子：
9
通讯作者：
Giulini, SM
中科院分区：
文献类型：
--
作者：
Portolani, N;Coniglio, A;Giulini, SM
目的：探讨肝细胞癌（HCC）术后肝内复发（IR）的预测因素、治疗及预后。背景资料：IR的预测因素存在争议。根据表现形式对复发进行分类有助于找到相关性，并为复发选择合适的治疗方法。方法：对213例患者进行评估。复发的危险因素与时间（< 2年和bbb2年）和表现类型（边缘性、结节性和弥漫性）有关。观察两组患者的预后及复发治疗情况。结果：143例患者出现IR；早期复发109例（第一组），晚期复发34例（第二组）。肝硬化、慢性活动性肝炎（CAH）和HCV阳性与复发风险独立相关，且具有累积效应（92.5%有3种预后因素的患者复发）。1组肿瘤血管浸润伴肝硬化、HCV阳性、CAH、转氨酶显著；11例伴有5项不良预后因素的患者均出现早期复发。相反，只有肝硬化与晚期复发有关。晚期生存率明显高于早期（61.9%,27.1%,25.7%，3-5年4.5%）；治疗1组67.6%，治疗2组29.3%。经IR根治性治疗后，生存率与无复发组相当。结论：早期和晚期复发与不同的预测因素有关。复发的表现形式以及根治的可行性是预后的最佳决定因素。
Objective: To evaluate the predictive factors, the therapy, and the prognosis of intrahepatic recurrence (IR) after surgery for hepatocellular carcinoma (HCC).Summary Background Data: The predictive factors of IR are debated. To class the recurrence according to the modality of presentation may help to find a correlation and to select the right therapy for the recurrence.Methods: A total of 213 patients were evaluated. Risk factors for recurrence were related to time (< 2 years and > 2 years) and type of presentation (marginal, nodular, and diffuse). Prognosis and therapy for the recurrence were studied in each group of patients.Results: IR was observed in 143 patients; 109 were early (group 1) and 34 late recurrences (group 2). Cirrhosis, chronic active hepatitis (CAH) and HCV positivity were independently related to the risk of recurrence with a cumulative effect (92.5% of recurrences in patients with 3 prognostic factors). For group 1, the neoplastic vascular infiltration together with cirrhosis, HCV positivity, CAH, and transaminases were significant; all the 11 patients with 5 negative prognostic factors showed an early recurrence. On the contrary, only cirrhosis was related to a late recurrence. Survival rate was significantly better in late than in early recurrence (61.9%, 27.1% and 25.7%, 4.5% at 3-5 years); a curative procedure was performed in 67.6% in group 1 and 29.3% in group 2. After a radical treatment of IR, the survival was comparable with the group of patients without recurrence.Conclusions: Early and late recurrences are linked to different predictive factors. The modality of presentation of the recurrence together with the feasibility of a radical treatment are the best determinants for the prognosis.