Long-term outcome of liver resection for hepatocellular carcinoma in noncirrhotic nonfibrotic liver with no viral hepatitis or alcohol abuse
Long-term outcome of liver resection for hepatocellular carcinoma in noncirrhotic nonfibrotic liver with no viral hepatitis or alcohol abuse
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DOI：
10.1007/s00268-007-9291-0
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发表时间：
2008-01-01
影响因子：
2.6
通讯作者：
Scotte, Michel
中科院分区：
文献类型：
--
作者：
Lubrano, Jean;Huet, Emmanuel;Scotte, Michel
研究背景肝细胞癌主要发生在肝硬变肝脏，正常肝组织中肝细胞癌的发生率不到10%。有限的研究描述了在完全正常的肝实质中进行肝切除的结果，没有肝硬变、纤维化、潜在的病毒性肝炎、酗酒或代谢紊乱综合征。材料与方法从1986年1月到2005年，共有321名患者因肝细胞癌而被转诊至我所。在这些患者中，20例(6.2%)接受了发生在非肝硬化性非纤维性肝实质的肝细胞癌的手术治疗；他们构成了我们的研究组。根据Chvallier纤维化评分和Metavir病毒评分对病理检查进行回顾。结果中位年龄57岁(35~80岁)，男性占71%。9例甲胎蛋白水平正常。14例术前诊断。发病率和死亡率分别为10%和5%。1、3、5年生存率分别为85%、70%、%，1、3、5年无瘤生存率分别为84%、66%、58%。8例复发，中位延迟15个月(2~70个月)。单因素分析显示，术前细胞溶解、R0切除、复发和1年内复发是影响生存率的因素。多因素分析显示复发和1年内复发显著降低生存率。复发患者的1、3、5年生存率分别为75%、37%和25%。结论肝实质正常的肝细胞癌患者行肝切除术是合理的，并强调了肝硬变患者肝细胞癌患者预后的差异。
Background Hepatocellular carcinoma (HCC) occurs primarily in cirrhotic liver, with less than 10% occurring in normal liver parenchyma. Limited studies have described the outcome of liver resection in strictly normal liver parenchyma with no cirrhosis, fibrosis, underlying viral hepatitis, alcohol abuse, or dysmetabolic syndrome.Materials and methods Between January 1986 and 2005, a total of 321 patients were referred to our institution for HCC. Of these patients, 20 (6.2%) underwent surgery for HCC arising in noncirrhotic nonfibrotic liver parenchyma; they comprise our study group. Pathology examinations were reviewed based on the Chevallier fibrosis score and the Metavir viral score. Pre-, per-, and postoperative data were collected to assess their influence on tumor recurrence and survival.Results The median age was 57 years (35-80 years), and 71% patients were male. alpha-Fetoprotein serum levels were normal in 9 patients. A preoperative diagnosis was made in 14 cases. Morbidity and morality rates were 10% and 5%, respectively. The 1-, 3-, and 5-year survival rates were 85%, 70%, and 64%, respectively; and disease-free survivals at 1, 3, and 5 years were 84%, 66%, and 58%, respectively. Eight patients had a recurrence with a median delay of 15 months (2-70 months). Univariate analysis showed that survival was influenced by preoperative cytolysis, R0 resection, recurrence, and recurrence within 1 year. A multivariate analysis revealed that recurrence and recurrence within 1 year significantly decreased survival. The 1-, 3-, and 5-year survival rates of patients with recurrence were 75%, 37%, and 25%, respectively.Conclusion These results for HCC in patients with normal liver parenchyma justify liver resection and underline the differences in outcome of patients with HCC in a cirrhotic liver.