Liver resection for hepatocellular carcinoma on cirrhosis - Univariate and multivariate analysis of risk factors for intrahepatic recurrence
Liver resection for hepatocellular carcinoma on cirrhosis - Univariate and multivariate analysis of risk factors for intrahepatic recurrence
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DOI：
10.1097/00000658-200304000-00016
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发表时间：
2003-04-01
影响因子：
9
通讯作者：
Cavallari, A
中科院分区：
文献类型：
--
作者：
Ercolani, G;Grazi, GL;Cavallari, A
目的探讨影响肝硬化合并肝细胞癌（HCC）切除术后无病生存率和复发率的预后因素。背景资料肿瘤复发是肝硬化合并HCC切除术后生存率低的主要原因。对几个临床病理变量进行单因素和多因素分析，以分析影响长期预后和肝内复发的因素。术前转氨酶水平和复发率之间的关系在整个组中进行了评估，并分别在HCV阳性和HBeAg阳性患者。结果全组1、3、5年生存率分别为83%、62.8%、42.5%。1、3、5年无瘤生存率分别为70.3%、43%、27.4%。术后1、3、5年复发率分别为20.8%、38.6%、54.4%。肿瘤复发93例（41.5%），是51例（56%）患者死亡的主要原因。结节数目、肿瘤包膜、门静脉微血管血栓形成和术前血清谷草转氨酶（AST）水平显著影响无病生存率和复发率。多因素分析显示，单个结节和术前AST水平低于正常值2倍（2N）与5年无病生存率和肿瘤复发率较低相关。特别是，在HCV阳性患者的复发率受到强烈的影响，术前AST level.Conclusions儿童A型患者的单结节是肝切除术的最佳人选。肿瘤复发与基础肝病的状态密切相关，术前AST水平等于2N似乎是具有不同复发风险的患者的敏感临界值。AST水平高于2N的HCV阳性患者肝内复发的风险最高，应仔细监测或提供替代治疗。
Objective To evaluate prognostic factors that could affect disease-free survival and recurrence after liver resection for hepatocellular carcinoma (HCC) on cirrhosis,Summary Background Data Tumor recurrence is the main cause of poor survival after liver resection for HCC on cirrhosis.Methods Two hundred twenty-four liver resections for HCC on cirrhosis were retrospectively reviewed. Univariate and multivariate analyses were performed on several clinicopathologic variables to analyze factors affecting long-term outcome and intrahepatic recurrence. The relation between preoperative aminotransferase level and recurrence rate was evaluated in the overall group, and separately in HCV-positive and in HBsAg-positive patients. Median follow-up was 35.6 months.Results The 1-, 3-, and 5-year overall survival rates were 83%, 62.8%, and 42.5%, respectively. The 1-, 3-, and 5-year disease-free survival rates were 70.3%, 43%, and 27.4%, respectively. The 1-, 3-, and 5-year recurrence rates were 20.8%, 38.6%, and 54.4% respectively. Tumor recurrence appeared in 93 patients (41.5%) and was the main cause of death in 51 patients (56%). Number of nodules, tumor capsule, microvascular portal vein thrombosis, and preoperative serum aspartate aminotransferase (AST) level significantly affected disease-free survival and recurrence rates. On multivariate analysis, single nodules and preoperative AST level less than twice normal (2N) were related to a better 5-year disease-free survival and lower tumor recurrence. In particular, among HCV-positive patients the recurrence rate was strongly affected by the preoperative AST level.Conclusions Child A patients with single nodules are the best candidates for liver resection. Tumor recurrence is strictly linked to the status of the underlying liver disease, and a preoperative AST level equal to 2N seems to be a sensitive cutoff among patients with different risks of recurrence. HCV-positive patients with AST levels above 2N have the highest risk for intrahepatic recurrence and should be monitored carefully or offered alternative treatments.