Additional Hepatocellular Carcinomas Undetectable before Surgery
Additional Hepatocellular Carcinomas Undetectable before Surgery
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手术前无法检测到的其他肝细胞癌
DOI：
10.1007/s002680010278
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发表时间：
2000
影响因子：
2.6
通讯作者：
H. Kinoshita
中科院分区：
文献类型：
--
作者：
T. Shuto;K. Hirohashi;T. Ikebe;S. Mikami;Takatsugu Yamamoto;S. Kubo;K. Wakasa;H. Kinoshita
肝切除术前无法检测到的小的额外肝细胞癌（HCC）的存在是肝外科医生的一个重要课题。我们评估了267例因肝癌行肝切除术的患者中病理诊断为多发性肝癌的发生率。在72例患者（27%）中检测到95个额外的HCC结节。这72例患者的生存率明显低于195例单发结节性HCC患者（p= 0.0013）。术前检测到21例（22%），术中检测到29例（31%），术后病理检查检测到45例（47%）。每组的平均结节直径分别为2.1、1.0和0.9 cm（p< 0.0001）。术前检测到的21个结节中没有一个分化良好，而其他两组中的74个结节中有30个分化良好。虽然高分化HCC组的平均结节直径最小，但根据肿瘤分化分配的三组之间无显著差异（p= 0.2355）。总的来说，16例术前检测到额外结节的患者中有9例（56%），59例术中或术后检测到额外结节的患者中有49例（88%）患有肝硬化。在肝硬化患者中，术中或术后检测到新的HCC结节的优势比为5.444（p= 0.0087）。对于肝硬化患者，术前和术中对小的额外HCC结节的检测以及术后细致的随访是必要的。对于无肝硬化的患者，可根据术前影像学检查结果进行手术治疗。
The presence of small additional hepatocellular carcinomas (HCCs) undetectable before hepatic resection is a crucial topic for hepatic surgeons. We assessed the incidence of pathologically diagnosed multiple HCCs in 267 patients who underwent hepatic resection for HCC. Ninety‐five additional HCC nodules were detected in 72 of the patients (27%). The survival rate of these 72 patients was significant worse than for the 195 with single nodular HCC (p= 0.0013). Twenty‐one (22%) were detected before surgery, 29 (31%) during surgery, and 45 (47%) on pathologic examination after surgery. The mean nodule diameters for each group were 2.1, 1.0, and 0.9 cm, respectively (p< 0.0001). None of the 21 nodules detected before surgery was well differentiated, whereas 30 of the 74 nodules in the other two groups were well‐differentiated. Although the mean nodule diameter of the well‐differentiated HCC group was the smallest, there was no significant difference among the three groups assigned according to tumor differentiation (p= 0.2355). Altogether, 9 of 16 patients with additional nodules detected before surgery (56%) and 49 of 59 with additional nodules detected during or after surgery (88%) had cirrhosis of the liver. The odds ratio for detecting a new HCC nodule during or after surgery in the presence of cirrhosis was 5.444 (p= 0.0087). Improvement in the detection of small additional HCC nodules before and during surgery and meticulous follow‐up after surgery are necessary for patients with cirrhosis. For patients without cirrhosis, surgical treatment may be performed according to the results of preoperative imaging studies.