Solitary Large Hepatocellular Carcinoma A Specific Subtype of Hepatocellular Carcinoma With Good Outcome After Hepatic Resection
Solitary Large Hepatocellular Carcinoma A Specific Subtype of Hepatocellular Carcinoma With Good Outcome After Hepatic Resection
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DOI：
10.1097/sla.0b013e3181904988
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发表时间：
2009-01-01
影响因子：
9
通讯作者：
Wu, Fan
中科院分区：
文献类型：
--
作者：
Yang, Lian-Yue;Fang, Feng;Wu, Fan
目的：评价比较大肝细胞癌（SLHCC）、小肝细胞癌（SHCC）和结节性肝细胞癌（NHCC）肝切除术后的临床和病理特点及预后。摘要背景资料：传统观点认为HCC的分型和预后取决于HCC的大小。因此，大的HCC通常被认为是晚期且不可切除的。然而，我们观察到一种独特类型的HCC-SLHCC，它体积大，但具有良好的临床、病理和分子生物学特征以及预后。方法：1992年1月至2002年12月，共481例确诊为肝癌并行肝切除术的患者。在这一系列患者中，回顾性分析了SLHCC患者（A组，n = 260）的临床和病理资料、手术结果和长期生存，并与SHCC患者（B组，n = 135）或NHCC患者（C组，n = 86）进行了比较。采用Cox比例风险模型对HCC术后预后因素进行单因素和多因素分析。结果：SLHCC与SHCC除肿瘤坏死和肿瘤大小外，临床病理特征相似。SLHCC患者手术时间明显长于SHCC，术中出血量、术中输血量、术后发病率均高于SHCC。然而，两组在住院时间和总发病率方面相似。A组和B组的总生存期和无病生存期相似且明显优于c组。多因素分析显示，术中大量输血和静脉侵犯是影响HCC患者总生存期的独立显著因素。结论：SLHCC的临床病理特点及肝切除术后转归与SHCC相似，但明显优于NHCC。我们建议将SLHCC作为HCC的一个特定亚型，并将肝切除术作为其标准治疗的选择。
Objective: To evaluate and compare the clinical and pathologic characteristics and outcomes after hepatic resection of large hepatocellular carcinoma (SLHCC), small HCC (SHCC), and nodular HCC (NHCC).Summary Background Data: Traditional viewpoint insists that the classification and prognosis of HCC are determined by the size of HCC. As a result, large HCC is often considered as advanced and unresectable. However, we have observed a unique type of HCC-SLHCC, which is large in size but exhibits good clinical, pathologic, and molecular biologic characteristics as well as prognosis.Methods: From January 1992 to December 2002, a total of 481 consecutive patients were diagnosed with HCC and received hepatic resection. In this series of patients, the clinical and pathologic data, surgical outcome, and long-term survival of patients with SLHCC (group A, n = 260) were analyzed retrospectively and compared with patients who had SHCC (group B, n = 135) or NHCC (group C, n = 86). Postresection prognostic factors of HCC were also evaluated by univariate and multivariate analysis using Cox's proportional hazards model.Results: The clinical and pathologic characteristics of SLHCC and SHCC were similar except for tumor necrosis and tumor size. Patients of SLHCC had significantly longer operative time, higher intraoperative blood loss, higher intraoperative blood transfusion, and higher postoperative morbidity than SHCC. However, the 2 groups were similar in duration of hospital stay and overall morbidity. Overall survival and disease-free survival in group A and group B were similar and significantly better than those in group C. Multivariate analysis revealed that large amount of intraoperative blood transfusion and vein invasion were independently significant factors for overall survival of patients with HCC.Conclusion: The clinical and pathologic characteristics and the outcome after hepatic resection of SLHCC are similar to that of SHCC, but significantly better than NHCC. We propose SLHCC as a specific subtype of HCC and hepatic resection as its choice of standard treatment.