Outcomes of non-anatomic liver resection for hepatocellular carcinoma in the patients with liver cirrhosis and analysis of prognostic factors
Outcomes of non-anatomic liver resection for hepatocellular carcinoma in the patients with liver cirrhosis and analysis of prognostic factors
复制标题
肝硬化患者非解剖性肝切除治疗肝癌的疗效及预后因素分析
DOI：
10.1007/s00423-010-0700-8
复制
发表时间：
2011-02-01
影响因子：
2.3
通讯作者：
Chen, Xiao-ping
中科院分区：
文献类型：
--
作者：
Huang, Zhi-yong;Chen, Gen;Chen, Xiao-ping
在东方国家，肝细胞癌（hepatocellular carcinoma，HCC）患者通常伴有不同程度的肝硬化，解剖性切除术的应用受到限制，尤其是对重度肝硬化患者。为探讨非解剖性切除术在肝癌合并肝硬化患者中的临床应用价值，同济医院自2003年1月至2006年12月连续77例肝癌合并肝硬化患者接受了非解剖性肝切除术。回顾性分析这些患者的临床资料、肝硬化严重程度和生存率，并分析影响预后的因素，1、2、3年总生存率和无病生存率分别为78%、68%、56%和66%、58%、55%。住院病死率为0%，住院并发症发生率为24.7%。1、2、3年总生存率轻度肝硬化为85.7%、77.1%、74.3%，中度肝硬化为81.5%、63%、48.1%，重度肝硬化为60.0%、53.3%、26.7%。不同程度肝硬化患者之间差异有统计学意义（P = 0.001）。多因素和单因素分析显示，肝硬化程度、肿瘤直径> 5cm、血管侵犯是独立的预后因素，对于轻度肝硬化或肿瘤直径<5cm的患者，非解剖性肝切除术的疗效与解剖性肝切除术相当。肝硬化严重程度是影响长期生存的独立因素。非解剖性切除术是治疗肝硬化合并肝癌的一种安全有效的手术方式。
In the east countries, patients with hepatocellular carcinoma (HCC) are usually associated with varied degrees of liver cirrhosis, and anatomic resection is therefore limited to use, especially in those with severe liver cirrhosis. This study aims to evaluate the clinical value of non-anatomic resection in HCC patients with cirrhosis.Seventy-seven consecutive HCC patients with cirrhosis underwent non-anatomic liver resection in Tongji Hospital from January 2003 to December 2006. The clinical data, severity of liver cirrhosis, and survival rates of these patients were retrospectively evaluated, and the prognostic factors were analyzed.One-, 2-, and 3-year overall and disease-free survival rates of this cohort of patients were 78%, 68%, 56%, and 66%, 58%, 55%, respectively. The hospital mortality and morbidity were 0% and 24.7%, respectively. The 1-, 2-, and 3-year overall survival rates were 85.7%, 77.1%, and 74.3% in the patients with mild cirrhosis, 81.5%, 63%, and 48.1% in the patients with moderate cirrhosis, and 60.0%, 53.3%, and 26.7% in the patients with severe cirrhosis, respectively. There was a significant difference among the patients with different grades of cirrhosis (P = 0.001). Multivariate and univariate analyses revealed that severity of cirrhosis, tumor diameter larger than 5 cm, and vascular invasion were independent prognostic factors.Non-anatomic liver resection for HCC could yield comparable outcomes with anatomic resection in the patients with mild cirrhosis or tumors diameter smaller than 5 cm. Severity of cirrhosis is an independent factor worsening long-time survival. Non-anatomic resection is a safe and effective surgical modality in the treatment of HCC patients with cirrhosis.