Efficacy of hepatic resection for hepatocellular carcinomas larger than 10 cm
Efficacy of hepatic resection for hepatocellular carcinomas larger than 10 cm
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DOI：
10.1007/s00268-004-7509-y
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发表时间：
2005-01-01
影响因子：
2.6
通讯作者：
Shimada, H
中科院分区：
文献类型：
--
作者：
Nagano, Y;Tanaka, K;Shimada, H
本研究的目的是评估肝切除术治疗大肝癌的疗效，并研究影响大肝癌切除术后总生存率的临床病理因素。比较26例肝癌>10 cm行肝切除术患者（A组）与143例肝癌≤ 10 cm患者（B组）的术前、术中、术后因素及远期疗效。大肝癌行肝切除的死亡率为3.8%，与B组（2.1%）相似。A组的总累积生存率（1年41.0%，3年29.3%，5年29.3%;中位生存期10.1个月）明显低于B组（1年93.1%，3年74.5%，5年44.7%;中位生存期53.4个月）（p < 0.0001）。多因素分析表明静脉侵犯是大肝癌患者生存的独立危险因素。有静脉侵犯的患者的总累积生存率（1年28.0%，3年0%;中位生存期6.4个月）明显低于无静脉侵犯的患者（1年64.8%，3.5年64.8%;中位生存期51.8个月）（p < 0.0066）。我们的结论是，肝切除术可以安全地进行肝癌>10厘米，死亡率低。我们有理由相信，肝切除是无静脉侵犯的大肝癌的治疗选择。
The objective of this study were to evaluate the efficacy of hepatic resection for large hepatocellular carcinomas (HCCs) and examine clinicopathologic factors influencing overall survival after resection of a large HCC. The pre-, intra-, and postoperative factors and long-term outcome of 26 patients with HCCs >10 cm who underwent hepatic resection (group A) were compared with the those of 143 patients with HCCs less than or equal to 10 cm (group B). Hepatic resection for large HCCs can be performed with a mortality rate of 3.8%, which was similar to the rate for group B (2.1%). The overall cumulative survival results for group A (1 year 41.0%, 3 years 29.3%, 5 years 29.3%; median survival 10.1 months) were markedly worse than those for group B (1 year 93.1%, 3 years 74.5%, 5 years 44.7%; median survival 53.4 months) (p < 0.0001). Multivariate analysis identified venous invasion as an independent risk factor of survival of patients with a large HCC. The overall cumulative survival results in patients with venous invasion (1 year 28.0%, 3 years 0%; median survival 6.4 months) were markedly worse than in patients without venous invasion (1 year 64.8%, 3.5 years 64.8%; median survival, 51.8 months) (p < 0.0066). We concluded that hepatic resection can be performed safely for HCCs >10 cm with a low mortality rate. It appears reasonable to believe that hepatic resection is the treatment of choice for large HCCs without venous invasion.