Treatment of fibrolamellar hepatoma with subtotal hepatectomy or transplantation.
Treatment of fibrolamellar hepatoma with subtotal hepatectomy or transplantation.
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采用肝次全切除或移植治疗纤维板层肝癌。
DOI：
10.1002/hep.510260412
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发表时间：
1997
期刊：
影响因子：
--
通讯作者：
Starzl,TE
中科院分区：
文献类型：
--
作者：
Pinna,AD;Iwatsuki,S;Lee,RG;Todo,S;Madariaga,JR;Marsh,JW;Casavilla,A;Dvorchik,I;Fung,JJ;Starzl,TE
纤维层状肝癌（FL-HCC）是一种罕见的肝细胞癌（HCC），其组织病理学特征表明其比传统HCC分化更大。然而，FL-HCC的最佳治疗方法和预后一直存在争议。41例FL-HCC患者接受部分肝切除术（PHx）（28例）或肝移植（13例）治疗后，随访时间为1年至27年。在这项回顾性研究中，确定了pTNM分期和手术时常规记录的其他预后因素对结果的影响。1年、3年、5年和10年的累积生存率分别为97.6%、72.3%、66.2%和47.4%。无瘤生存率分别为80.3%、49.4%、33%和29.3%。TNM分期与无肿瘤生存期显著相关。淋巴结阳性患者的无瘤生存期比淋巴结阴性患者短（P< 0.05）。015)。存在血管侵犯对患者生存影响最大（P< 0.05）。05)。FL-HCC是一种惰性生长的肝脏肿瘤，通常在我们的患者中被诊断为过于先进的阶段，而大多数传统的HCC无法进行有效的手术治疗。然而，通过积极的手术治疗，患者往往能长期存活。当不能行次全肝切除术时，全肝切除术加肝移植是一个有价值的选择。
Fibrolamellar hepatoma (FL-HCC) is an uncommon variant of hepatocellular carcinoma (HCC), distinguished by histopathological features suggesting greater differentiation than conventional HCC. However, the optimal treatment and the prognosis of FL-HCC have been controversial. Follow-up studies are available from 1 year to 27 years, after 41 patients with FL-HCC were treated with partial hepatectomy (PHx)(28 patients) or liver transplantation (13 patients). In this retrospective study, the effect on outcome was determined for the pTNM stage and other prognostic factors routinely recorded at the time of surgery. Cumulative survival at 1, 3, 5, and 10 years was 97.6%, 72.3%, 66.2%, and 47.4%. Tumor-free survival at these times was 80.3%, 49.4%, 33%, and 29.3%. The TNM stage was significantly associated with tumor-free survival. Patients with positive nodes had a shorter tumor-free survival than those with negative nodes (P<. 015). Patient survival was most adversely affected by the presence of vascular invasion (P<. 05). FL-HCC is an indolently growing tumor of the liver, which usually was diagnosed in our patients at a stage too advanced for effective surgical treatment of most conventional HCC. Nevertheless, long-term survival frequently was achieved with aggressive surgical treatment. When a subtotal hepatectomy could not be performed, total hepatectomy (THx) with liver transplantation was a valuable option.
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