Risk factors and management for early and late intrahepatic recurrence of solitary hepatocellular carcinoma after curative resection
Risk factors and management for early and late intrahepatic recurrence of solitary hepatocellular carcinoma after curative resection
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作者：
Cheng, Zhangjun;Yang, Pinghua;Shen, Feng
背景肝内复发是肝细胞癌(HCC)患者肝切除后的一个重要问题。本研究的目的是找出孤立性肝癌根治性切除后早期和晚期复发的危险因素，并评估其治疗方法。方法816例孤立性肝癌患者接受了根治性肝部分切除术。对这些患者的肝内复发进行了回顾性随访。结果早期肝内复发423例，晚期肝内复发199例。多因素分析显示，肿瘤直径<5 cm、无肿瘤包膜和微血管侵犯与早期复发相关，而肝硬变和甲胎蛋白400g/L是影响晚期复发的独立危险因素。早期复发的肝癌患者的5年生存率明显低于晚期复发的患者。对肝内复发的进一步根治治疗，5年总生存率为56.0%，优于其他治疗方法。结论孤立性肝癌根治性切除后早期复发和晚期复发与不同的预测因素有关。复发时间和复发后的进一步治疗是复发后生存的最好预测因素。
BackgroundIntrahepatic recurrence is a significant problem for patients who have undergone a hepatic resection for hepatocellular carcinoma (HCC). The objective of the present study was to identify risk factors and evaluate the management of early and late recurrence of solitary HCC after curative resection.MethodsIncluded in this study were 816 patients with solitary HCC who underwent a curative partial hepatectomy. Intrahepatic recurrence in these patients was followed up retrospectively. Prognosis and therapy for the recurrence were investigated and analysed.ResultsEarly and late intrahepatic recurrence occurred in 423 patients and 199 patients, respectively. Multivariate analysis showed that a tumour diameter >5cm, the absence of a tumour capsule and the presence of microvascular invasion were correlated with early recurrence, whereas cirrhosis and alpha-fetal protein >400g/l were independent risk factors contributing to late recurrence. The 5-year survival of HCC patients with early recurrence was significantly lower than that of patients with late recurrence. Further curative treatment for intrahepatic recurrence offered a 5-year overall survival of 56.0%, which was better than alternative management.ConclusionEarly and late recurrences of solitary HCC after curative resection are associated with different predictive factors. The time to recurrence and further curative treatment after recurrence were the best predictors of survival post recurrence.