Indications for hepatectomy for hepatocellular carcinoma - what stage of the disease is the best indication for surgery?
Indications for hepatectomy for hepatocellular carcinoma - what stage of the disease is the best indication for surgery?
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DOI：
10.1007/pl00009944
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发表时间：
1998-01-01
期刊：
影响因子：
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通讯作者：
Inoue, E
中科院分区：
文献类型：
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作者：
Sasaki, Y;Imaoka, S;Inoue, E
为确定肝细胞癌（HCC）最适合手术的临床和肿瘤分期，对接受肝切除手术患者的术后长期结果进行了回顾性研究。在975例接受局部治疗的肝细胞癌患者中，384例（39%）接受了肝切除（HR），534例（55%）接受了经导管动脉化疗栓塞（TACE），其余57例（6%）接受了肿瘤内无水乙醇注射（PEI）。采用日本肝癌研究组制定的标准进行分期和肝功能储备评估（即临床分期）。在133例I期肝细胞癌患者中，肝切除组、经导管动脉化疗栓塞组和无水乙醇注射组的生存率无显著差异。在314例II期肝细胞癌患者中，肝切除组的5年和7年生存率分别为51%和46%，经导管动脉化疗栓塞组分别为23%和10%，无水乙醇注射组均为0%。肝切除组的生存率显著优于经导管动脉化疗栓塞组和无水乙醇注射组（P < 0.001）。临床I期（即肝功能良好）的II期肝细胞癌患者接受肝切除后的5年和10年生存率分别为64%和47%，显著优于临床II期（即肝功能不良）患者的5年和10年生存率（32%和23%）（P < 0.0001）。II期肝功能良好的患者有望获得更好的生存率，被认为最适合肝切除手术。
To determine the clinical and tumor stage of hepatocellular carcinoma (HCC) that is the best indication for surgery, the postoperative long-term outcomes of patients who underwent hepatic resection were examined retrospectively. Of 975 patients with HCC who underwent regional therapy, 384 patients (39%) received hepatic resection (HR), 534 (55%) had transcatheter arterial chemoembolization (TACE), and the remaining 57 (6%) received percutaneous ethanol injection (PEI) into the tumor. The criteria defined by liver Cancer Study Group of Japan was used for staging and liver functional reserve (i.e., clinical staging). In the 133 patients with stage I HCC, there were no significant differences among the survivals of the HR, TACE, and PEI groups. In the 314 patients with stage II HCC, the 5- and 7-year survival rates were 51% and 46% in the HR group, 23% and 10% in the TACE group, and 0% and 0% in the PEI group. The survival of the HR group was significantly better than the survivals of the TACE and PEI groups (P < 0.001). The 5- and 10-year survivals of the stage II HCC patients who had HR were 64% and 47% in the clinical stage I (i.e., good liver function) group, significantly better than the 5; and 10-year survivals (32% and 23%) in the clinical stage II (i.e., bad liver function) group (P < 0.0001). Patients with good liver function in stage II are expected to have better survival and are considered to be the most suitable for HR.