Anatomic resection independently improves long-term survival in patients with T1-T2 hepatocellular carcinoma
Anatomic resection independently improves long-term survival in patients with T1-T2 hepatocellular carcinoma
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DOI：
10.1245/s10434-006-9318-z
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发表时间：
2007-04-01
影响因子：
3.7
通讯作者：
Hatakeyama, Katsuyoshi
中科院分区：
文献类型：
--
作者：
Wakai, Toshifumi;Shirai, Yoshio;Hatakeyama, Katsuyoshi
背景资料：本研究旨在评估解剖切除术对病理T1-T2（pT 1-T2）肝细胞癌患者长期预后的影响。方法：对158例连续的pT 1-T2肝细胞癌患者进行回顾性分析，这些患者接受解剖（n = 95）或非解剖（n = 63）切除术。解剖性切除定义为完全切除至少一个包含肿瘤的Couinaud节段;非解剖性切除定义为切除肿瘤加上非肿瘤性肝实质边缘。中位随访时间为83 months.Results：与接受非解剖切除术的患者相比，接受解剖切除术的患者肝硬化患病率较低（P = 0.015），肝功能更好（P = 0.001），肿瘤大小更大（P = 0.029），血管浸润患病率更高（P = 0.008）。解剖切除术的生存率（中位生存时间，122个月）优于非解剖切除术（中位生存时间，76个月; P = 0.0358）。接受解剖切除术的患者无病生存率更高（P = 0.0121）。解剖切除独立地提高了生存率（风险比，0.46; P = 0.003）和无病生存率（风险比，0.55; P = 0.008）。当按pT分类分层时，解剖切除术的有效性仅在pT 2肿瘤患者的生存率（P = 0.0012）和无病生存率（P = 0.0004）方面保持不变。结论：解剖切除术独立地提高了T1-T2肝细胞癌患者的长期生存率，这可能是因为切除区域内静脉肿瘤血栓的清除。
Background: This study aimed to evaluate the effect of anatomic resection on long-term outcomes in patients with pathologic T1-T2 (pT1-T2) hepatocellular carcinoma.Methods: A retrospective analysis of 158 consecutive patients who underwent either anatomic (n = 95) or nonanatomic (n = 63) resection for pT1-T2 hepatocellular carcinoma was conducted. Anatomic resection was defined as the complete removal of at least one Couinaud segment containing the tumor; nonanatomic resection was defined as removal of the tumor plus a rim of nonneoplastic liver parenchyma. The median follow-up time was 83 months.Results: Patients who underwent anatomic resection were characterized by lower prevalence of cirrhosis (P = .015), more favorable hepatic function (P = .001), larger tumor size (P = .029), and higher prevalence of vascular invasion (P = .008) compared with patients who underwent nonanatomic resection. Anatomic resection provided better survival (median survival time, 122 months) than nonanatomic resection (median survival time, 76 months; P = .0358). Patients who underwent anatomic resection had better disease-free survival (P = .0121). Anatomic resection independently improved both survival (hazard ratio, .46; P = .003) and disease-free survival (hazard ratio, .55; P = .008). When stratified for pT classification, the effectiveness of anatomic resection remained only in patients with pT2 tumors in terms of survival (P = .0012) and disease-free survival (P = .0004).Conclusions: Anatomic resection independently improves long-term survival in patients with T1-T2 hepatocellular carcinoma, probably because of the clearance of venous tumor thrombi within the resected domain.