Long-term prognosis after resection of hepatocellular carcinoma associated with hepatitis B-related cirrhosis
Long-term prognosis after resection of hepatocellular carcinoma associated with hepatitis B-related cirrhosis
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DOI：
10.1200/jco.2000.18.5.1094
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发表时间：
2000-03-01
影响因子：
45.3
通讯作者：
Wong, J
中科院分区：
文献类型：
--
作者：
Poon, RTP;Fan, ST;Wong, J
目的：肝细胞癌（HCC）合并肝硬化的最佳治疗尚未明确。文献中很少有关于肝细胞癌（HCC）合并乙型肝炎病毒（HBV）相关肝硬化切除术后预后的数据。本研究评估了肝细胞癌合并乙肝相关肝硬化切除术后的长期结果和预后因素。患者和方法：我们前瞻性研究了146例在10年内接受肝细胞癌切除术的乙肝相关儿童A或B肝硬化患者的长期结果。他们与同期切除的155名非肝硬化hbv相关HCC患者进行了比较。结果：HCC切除术后肝硬化患者的总体生存结果与非肝硬化患者相当（5年生存率分别为44.3%和45.6%,P = 0.216），但前者的肿瘤明显较小。根据肿瘤大小进行分层，肿瘤小于或等于5 cm的肝硬化和非肝硬化患者的生存结果相似（5年生存率分别为60.7% vs 61.7%, P = 0.327），但肿瘤大于5 cm的肝硬化患者的生存结果比非肝硬化患者差（5年生存率分别为27.8% vs 39.5%, P = 0.034）。分阶段，肝硬化和非肝硬化患者的生存结果无显著差异。术前血清AST浓度大于100 IU/L （P = 0.004）、围手术期输血（P = 0.015）、静脉侵犯（P < 0.001）是独立的不良预后因素。结论：代偿性hbv相关肝硬化患者切除小于5 cm的hcc后的预后与非肝硬化患者相当，这表明手术切除可能被认为是这些患者的一线治疗方法。术前转氨酶水平较高的潜在活动性肝炎患者不适合进行肝切除。对于伴有乙型肝炎肝硬化的HCC，需要进一步的研究来确定肝切除和肝移植的相对作用。[J]中华临床杂志，18(10):391 - 391。(C) 2000年由美国临床肿瘤学会出版。
Purpose: The optimum management of hepatocellular carcinoma (HCC) associated with cirrhosis has not yet been clarified. Very few data are available in the literature regarding the prognosis after resection of HCC associated with hepatitis B virus (HBV)-related cirrhosis. This study evaluated the long-term results and prognostic factors after resection of HCC complicating HBV-related cirrhosis,Patients and Methods: One hundred forty-six patients with HBV-related Child's A or B cirrhosis who had undergone resection of HCC over a 10-year period were prospectively studied for long-term results. They were compared with 155 noncirrhotic patients with HBV-related HCC resected in the same period.Results: The overall survival results of cirrhotic patients after resection of HCC were comparable to those of noncirrhotic patients (5-year survival, 44.3% v 45.6%, respectively; P = .216), bur the former group had significantly smaller tumors. Stratified according to tumor size, the survival results were similar between cirrhotic and noncirrhotic patients with tumors less than or equal to 5 cm (5-year survival, 60.7% v 61.7%, respectively; P = .327) but were worse in cirrhotic compared with noncirrhotic patients with tumors greater than 5 am (5-year survival, 27.8% v 39.5%, respectively; P = .034). Stage by stage, there were no significant differences in survival results between cirrhotic and noncirrhotic patients. Preoperative serum AST revel greater than 100 IU/L (P = .004), perioperative transfusion (P = .015), and venous invasion (P < .001) were independent adverse prognostic factors.Conclusion: The prognosis after resection of HCCs less than 5 cm in patients with compensated HBV-related cirrhosis was comparable to that of noncirrhotic patients, which suggests that surgical resection may be considered a first-line treatment for these patients. patients with underlying active hepatitis as indicated by a high preoperative transaminase level are less favorable candidates for resection, Further studies are needed to define the relative roles of resection and transplantation for HCC associated with hepatitis B cirrhosis. J Clin Oncol 18:1094-1101. (C) 2000 by American Society of Clinical Oncology.