手术切除治疗巨大原发性肝癌的预后因素分析

目的 研究巨大原发性肝癌患者手术切除治疗后的预后影响因素,寻找改善巨大原发性肝癌患者预后的方法。方法 回顾性分析69例手术切除治疗的巨大原发性肝癌患者的临床资料,采用Cox回归模型对16个可能与患者预后有关的因素进行统计学分析。结果 58例患者获得随访,随访患者的l、3、5年生存率分别为58.2％、31.4％和12.3％。单因素分析的结果显示,有无肝内转移、有无血管侵犯、肝硬化程度和是否行根治性切除与巨大原发性肝癌手术切除治疗后患者的预后有关（均P＜0.05）。Cox多因素回归分析的结果显示,肝硬化程度、有无肝内转移和是否行根治性切除是影响巨大原发性肝癌患者手术切除治疗后预后的独立因素（均P＜0.05）。结论 积极行手术切除是治疗巨大原发性肝癌的主要措施,其预后取决于是否伴有肝内转移、肝硬化程度和是否行根治性切除。     

67例肝细胞肝癌合并重度肝硬化的手术疗效分析

背景与目的:肝细胞肝癌(下称肝癌)合并重度肝硬化,由于肝储备功能差,手术风险明显增高.本研究探讨肝癌合并重度肝硬化的手术安全性、疗效和预后影响因素.方法:回顾性分析我院1998年至2003年经手术切除的67例肝癌合并重度肝硬化的患者资料,根据随访结果计算生存率并作单因素和多因素分析.结果:3例围手术期死亡.术后1、3、5年累积生存率分别为62.6%、46.7%、19.9%.单因素分析结果表明预后影响因素为术前Child-Pugh分级、吲哚靛青绿15 min储备率(ICGR15)、血小板计数、肿瘤大小、肿瘤数目和是否根治性切除;多因素分析得出影响疗效的独立预后因素为术前Child-Pugh分级和是否根治性切除.结论:正确的术前肝储备功能评估,可增加手术切除的安全性,使部分合并重度肝硬化的肝癌患者获得手术根治的机会.术后辅助治疗有助提高患者生存率.     

41例肝内胆管细胞癌的临床特点及其预后观察

目的：评价肝内胆管细胞癌的临床特点和治疗方法及预后相关因素以指导临床诊治，提高生存率。方法：分析中国医学科学院肿瘤医院1970年1月～2005年1月收治的41例肝内胆管细胞癌患者的临床资料．所有患者均获随访。结果：41例患者中AFP阳性率9．8％（4／41），肝硬化阳性率22．0％（9／41）。根治性切除组1、3、5年生存率82.3％、45．8％、45．8％；非根治性切除组1、3年生存率9．2％、0％。Cox比例风险模型多因素分析根治性切除（P〈0．01）、淋巴结转移（P〈0．01）、术前直接胆红素水平（P=0．012）是影响预后的独立因素。结论：肝内胆管细胞癌以手术治疗为主。根治性手术切除是获得长期生存的唯一途径。根治性切除、淋巴结转移、术前胆红素水平是影响预后的独立因素。     

84例肝内胆管细胞癌患者预后因素分析

背景与目的：肝内胆管细胞癌（intrahepatic cholangiocarcinoma,ICC）发病率低,治疗效果不理想。本研究旨在分析可手术治疗和无法手术治疗ICC患者的预后相关因素和生存情况。方法：回顾性收集1997年1月至2007年12月在中山大学肿瘤防治中心经病理诊断并治疗的84例ICC患者的临床资料,采用Kaplan—Meier法进行单因素生存分析,用Cox模型进行多因素分析。结果：84例患者中采用手术治疗者56例（66．7％）,非手术治疗者28例（33．3％）;手术治疗者中根治性切除者27例（48．2％）,姑息性切除者29例（51．8％）。无法手术治疗患者、姑息手术治疗患者及根治性手术治疗患者的2年总生存率分别是3．1％、16．0％及49．2％．根治性切除患者的2年生存率明显高于姑息性切除患者（P〈0．01）。对手术患者进行单因素生存分析,结果显示。手术方式、病理类型、肿块大小、肿块数目、淋巴结侵犯、肝脏侵犯、门脉癌栓、术后血清白蛋白水平和术前血清CEA、CA199、TBIL、ALT、AST水平与预后相关;多因素生存分析结果显示。手术方式、病理类型和术前血清CEA、CA199、TBIL水平是手术患者的独立预后因素。未手术患者的单因素生存分析结果显示病理类型和血清CA199水平与预后相关。多因素生存分析结果显示只有病理类型为独立预后因素。化疗在手术患者组和非手术患者组均未显示生存优势（P=0．30和P=0．78）。结论：根治性切除是ICC患者获得长期生存的主要有效治疗手段。术前血清CEA、CA199、TBIL水平是手术患者重要的预后因素。     

微波肝切除治疗肝癌的远期疗效

目的研究微波肝切除治疗肝癌的远期疗效。方法５４例原发性肝癌因严重肝硬化或肝脏萎缩行微波肝切除,以３０８例原发性肝癌手术根治性切除作对照。结果微波组术后一、三、五年生存率分别为９０５％、６８８％、５４７％;有１４例（２５９％）复发,术后一、三、五年复发率分别为４８％、２８０％、４８１％。微波组合并严重肝硬化、肿瘤包膜不完整者多（Ｐ＜００１）,但与根治性切除组的远期疗效无显著性差异（Ｐ＞００５）。结论微波肝切除使部分合并严重肝硬化的肝癌患者获得肿瘤切除机会,并可能取得与根治性切除同样好的远期疗效     

肝癌患者术前,术后全血硒含量与预后的关系

目的：探讨肝癌不同临床分期术前、术后全血硒含量与预后关系。方法：采用２、３－二氨基苯荧光测定全血硒含量，并用寿命表计算。结果：１９９０年５月至１９９２年５月收集我院经手术切除病理确诊为原发性肝癌患者４５例，全血硒的含量（０．１１７±０．０２５μｇ／ｍｌ）比健康人７４例的含量（０．１３０±０．０２３μｇ／ｍｌ）偏低（Ｐ＜０．２）；经治疗后３年以上生存２０例，占４４．４％，在术前或术后全血硒的含量比生存３年以下（２５例）偏高（Ｐ＜０．２）；除无伴肝硬化肝癌生存３年以上（５例）术前或术后含量比３年以下（２例）有明显增高（Ｐ＜０．０５）外，小肝癌、巨大肝癌、伴中重度肝硬化肝癌分别在生存３年以上术前后血硒含量比３年以下均无明显差异；但是，小肝癌血硒含量比巨大肝癌有明显增高，小肝癌３年生存率７６．９％，巨大肝癌生存率仅占７．９％；无伴肝硬化肝癌血硒含量比伴中重度肝硬化明显增高，前者３年生存率为７１．４％，后者生存率３０．８％。结论：肝癌患者术前后血硒含量接近健康人的水平预后较好，患者比健康人水平越低预后较差。     

非肝硬化肝癌患者的临床特征及手术疗效分析

目的 本研究旨在对非肝硬化肝癌患者的临床特征及手术疗效进行总结.方法 采用本中心自1995年至2001年问手术切除的96例经组织学证实的非肝硬化肝细胞癌患者,回顾性分析其临床病理学特征、术后生存情况及预后因素.结果 无手术死亡,术后并发症发生率为8.3%(8/96).术后1年、3年、5年、10年的总生存率分别为84.4%、62.5%、47.9%及38.2%,中位生存期为57个月.术后1年、3年、5年的无瘤生存率分别为56.3%、39.6%、33.3%,中位无瘤生存期为18个月.TNM分期是患者总生存及无瘤生存的独立预后因素.术中出血是影响行治愈性切除手术患者预后的独立因素.结论 治愈性局部肝切除是非肝硬化肝癌有效和安全的治疗方法.对术后肝内复发的患者建议采取积极的局部治疗以延长生存.     

肝癌术后生存10年以上29例临床研究

原发性肝癌(下称肝癌)恶性程度高,术后5年生存率一般约为20％,生存10年以上者很少见。本所自1972年以来,肝癌术后生存≥10年者共29例,10年生存率为16.5％(29/176)。本文通过对照分析这些病例和其它手术病例的疗效,研究影响术后远期生存的主要因素及提高疗效的措施。     

青年肝癌患者术前中性粒细胞与淋巴细胞比值与预后的相关性

背景与目的：中性粒细胞与淋巴细胞比值（neutrophil-to-lymphocyte ratio,NLR）作为炎症反应评价指标,已被认为是肝癌的预后因素。本研究探讨接受根治性手术的青年肝癌患者术前NLR与预后的相关性。方法：回顾性分析91例2000—2005年间诊断为原发性肝细胞肝癌,年龄小于35周岁,并接受根治性切除术的患者临床资料．根据患者术前外周静脉血NLR大小分为低NLR组（NLR≤2）和高NER组（NLR〉2）,分析两组患者NLR与各自的无瘤生存时间、总生存时间之间的关系。结果：低NLR组患者1年、3年无瘤生存率为85．3％和80．0％．总生存率为92．9％和85．6％;高NLR组患者1年、3年无瘤生存率为69．1％和43．5％,总生存率为89．8％和57．1％,组间差异有统计学意义（P〈0．01）。Cox回归模型提示术前NLR〉2和肿瘤大小是青年肝癌患者无瘤生存和总生存的危险因素。结论：NLR〉2是达到Ⅲ级根治切除标准青年肝癌患者的预后危险因素。     

肝外胆管癌161例的外科治疗和预后分析

目的：探讨肝外胆管癌（extrahepatic cholangiocarcinoma，EHCC）的临床特征和治疗方法对患者远期生存率的影响及EHCC切除术后的预后因素。方法：对1995年4月至2006年7月收治的161例EHCC患者的临床特点、诊断、手术方式和随访结果进行回顾分析。选择对EHCC切除术后的预后可能产生影响的临床因素，通过COX比例风险模型进行多因素预后分析。结果：161例手术治疗的EHCC，根治性切除110例，姑息性切除32例，引流或探查19例。161例患者总体1、2、3、5年生存率分别为74．9％、45．3％、36．5％和11．1％。COX分析结果表明肝脏浸润、门脉或肝动脉侵犯和淋巴结转移是EHCC根治切除影响预后的独立因素（P〈0．05）。结论：根治性切除是提高EHCC患者远期生存率及改善生活质量的关键，肝叶切除和（或）胰十二指肠切除联合骨骼化切除是提高根治切除率及远期疗效的重点。     

原发性肝癌的综合治疗--附607例报告

背景与目的：虽然原发性肝癌(简称肝癌)的早期诊断和早期治疗取得了很大进步,但大多数为合并有肝硬化的中晚期肝癌患者,手术切除并非适合所有肝癌患者,即使能切除,术后复发率也高达60％以上,因而,肝癌的整体治疗效果较差。本研究探讨肝癌的综合治疗方法,以进一步提高肝癌的整体治疗效果。方法：回顾性分析我科以外科为主综合治疗的607例肝癌患者的病例资料,其中,手术切除共423例,行不规则性肝叶切除134例,局部切除95例,肝叶或肝段切除123例,半肝或半肝以上切除共54例,联合脏器切除17例;手术不能切除184例,行肝固有动脉结扎联合肝动脉及门静脉双插管化疗或瘤体内注射无水乙醇或冷冻、射频治疗、微波固化、腹腔化疗等。结果：总的手术切除率69．7％(423／607),手术死亡率1．2％(5／423);全组3、5、10年生存率分别为42．7％(218／511)、37．5％(123／328)和26．5％(26／98);切除组3、5、10年生存率分别为57．2％(203／355)、51．3％(118／230)和35．3％(24／68);不能切除组3、5、10年生存率分别为9．6％(15／156)、5．1％(5／98)和6．7％(2／30)。结论：以外科为主的综合治疗是目前可切除肝癌较好的治疗方法。术后个体化综合治疗可提高肝癌的手术治疗效果。     

RESULTS OF HEPATECTOMY FOR HUGE PRIMARY LIVER CANCER

ＲＥＳＵＬＴＳＯＦＨＥＰＡＴＥＣＴＯＭＹＦＯＲＨＵＧＥＰＲＩＭＡＲＹＬＩＶＥＲＣＡＮＣＥＲＬｉＧｕｏｈｕｉ；李国辉；ＬｉＪｉｎｑｉｎｇ；李锦清；ＺｈａｎｇＹａｑｉ；张亚奇；ＣｕｉＳｈｕｚｈｏｎｇ；崔书钟；ＹｕａｎＹｕｎｆｅｉ；元云飞（ＴｕｍｏｒＨｏｓ...     

Long-term survivors after resection for primary liver cancer. Clinical analysis of 19 patients surviving more than ten years

From July 1958 to June 1978, a total of 333 cases with pathologically proven primary liver cancer (PLC) were admitted to the Zhong Shan Hospital, Shanghai Medical University, Shanghai, the people's Republic of China. Of these, 39.6% (132 of 333) were resected and 14.4% (19 of 132) survived over 10 years after resection for PLC. These 19 patients surviving over 10 years were investigated in this paper. All 19 patients underwent radical resection, including right hemihepatectomy in two cases, left hemihepatectomy in ten cases, left lateral segmentectomy in three cases, and local resection in four cases. By the end of June 1988, follow-up varied from 10 years and 1 month to 26 years and 7 months, with a mean follow-up of 15 years and 4 months. All 19 patients are still alive with free of disease. The longest survival patient had a tumor measuring 10 X 8 X 6 cm in size and underwent local resection. Upon follow-up after 26 years and 7 months, the patient was found to be still living and well. Two patients with intraperitoneal ruptured PLC have survived for 19 years and 4 months, and 16 years and 11 months, respectively, after resection of the tumors free of disease and have returned to work. Subclinical recurrence of PLC was discovered in one patient in whom reoperation with cryosurgery was carried out. The patient has been in good condition with negative alpha-fetoprotein (AFP) for 8 years and 10 months after cryosurgery. Subclinical solitary pulmonary metastasis was detected in two patients because of a secondary rise in AFP level. Reoperations were carried out and the metastatic tumors were removed. These two patients are still in good health with negative AFP 9 years and 6 months, and 10 years and 1 months, respectively, after reoperation. These results indicate that early and radical resection are the principal factors influencing long-term survival; reoperation for subclinical recurrence and solitary metastasis remains an important approach to prolong survival further; intraperitoneal rupture of PLC does not exclude the possibility of cure; new surgical techniques, such as cryosurgery and bloodless hepatectomy, have been shown to be effective in some patients.     

Repeat hepatectomy for colorectal liver metastases: A worthwhile operation?

BACKGROUND AND OBJECTIVES: After curative resection of hepatic colorectal metastases, 10-20% of patients experience a resectable hepatic recurrence. We wanted to assess the expected risk-to-benefit ratio in comparison to first hepatectomy and to determine the prognostic factors associated with survival. METHODS: Twenty-nine patients from a group of 152 patients resected for colorectal liver metastases underwent 32 repeat hepatectomies. RESULTS: In-hospital mortality was 3.5% (1/29 patients); the morbidity after repeat hepatectomy was lower than that after first hepatic resection. Combined extrahepatic surgery was performed on 34.5% of repeat hepatectomies vs. 6.9% of first hepatectomies (P = 0.01). Overall actuarial 3-year survival was 35.1%: four patients have survived more than 3 years and one survived for more than 5 years. The number of hepatic metastases and the carcinoembryonic antigen (CEA) serum levels were significant prognostic factors on univariate analysis. The synchronous resection of hepatic and extrahepatic disease was not associated with a lower survival rate when compared with that of patients without extrahepatic localization: three patients of the former group are alive and disease-free at more than 2 years. CONCLUSIONS: Repeat hepatic resection can provide long-term survival rates similar to those of first liver resection, with comparable mortality and morbidity. The presence of resectable extrahepatic disease must not be an absolute contraindication to synchronous hepatectomy because long-term survival is possible.     

原发性肝癌以外科为主的综合治疗(附425例报告)

目的：探讨肝癌以外科为主的综合治疗。方法：以外科为主综合治疗原发性肝癌患者425例，其中直径≤5cm的小肝癌121例。行不规则性肝叶切除134例，局部切除95例，肝叶或肝段切除123例，半肝或半肝以上切除共56例，联合脏器切除17例；切缘注射无水酒精或用渗入无水酒精的明胶海绵包埋于瘤床共39例。结果：总的手术切除率69.8%，小肝癌手术切除率90.3%；手术死亡率1.2%；术后生存5年以上118例，10年以上24例。全组术后3、5、10年生存率分别为57.2%(203/355)、51.3%(118/230)和35.3%(24/68)；其中小肝癌术后3、5、10年生存率分别为74.4%(64/86)、64.6%(42/65)和43.8%(14/32)。结论：以外科为主的综合治疗是目前治疗肝癌最有效的方法。不规则性肝切除、早期发现肝癌、综合治疗大肝癌缩小后二期切除等是提高手术切除率的主要手段；以个体化为原则的术后综合治疗可降低术后复发率，提高肝癌的治疗效果。     

Prognostic factors of hepatic resection for hepatocellular carcinoma with cirrhosis: univariate and multivariate analysis

BACKGROUND AND OBJECTIVES: The objective of this investigation was to study the clinicopathological factors influencing long-term outcome of hepatocellular carcinoma (HCC) with liver cirrhosis in patients undergoing hepatectomy. Liver cirrhosis, especially the macronodular variety, has been found in up to 90% of patients with HCC. In Asia, the incidence of liver cirrhosis in patients with HCC who had undergone hepatic resection varies from 42.5% to 73.8%. However, the optimal surgical approach for HCC patients with cirrhosis is less clearly defined. Resection of the cirrhotic liver is challenging and remains controversial in the treatment of HCC. METHODS: This study retrospectively analyzed the surgical outcomes of HCC concomitant with liver cirrhosis in 218 patients who underwent hepatic resection between 1986 and 1998. Post-resection prognostic factors were assessed using a univariate log-rank test and a multivariate Cox proportional hazards model. RESULTS: The overall postoperative complication rate was 15.6%, while the surgical mortality rate was 8.8%. Meanwhile, the 1-, 3-, and 5-year disease-free survival rates were 50.9%, 33.98%, and 27.03%, respectively, and. the overall cumulative survival rates at 1, 3, and 5 years were 63.14%, 41.88%, and 31.83%, respectively. Applying Cox's multivariate proportional hazard model indicated that significant adverse prognostic indicators included elevated alkaline phosphatase value, tumor size >2 cm, presence of satellite lesions, and vascular invasion. CONCLUSIONS: This investigation found that overall survival for HCC patients concomitant with liver cirrhosis who underwent hepatic resection should be stratified on the basis of the high value of alkaline phosphatase, tumor size, satellite lesions, and vascular invasion.     

Repeat liver resection for recurrent liver metastases from colorectal cancer.

AIMS: Numerous patients suffer from recurrence after resection of liver metastases from colorectal cancer. Recurrence is frequently restricted to the liver and repeat liver resection may offer a curative option in these patients. This study was conducted to clarify safety and effectiveness of this treatment and to identify prognostic factors of a favourable outcome after repeat hepatectomy. METHODS: Between January 1988 and March 2006 in our institution 811 patients underwent 841 liver resections for metastases from colorectal cancer. Among these, 94 patients underwent a repeat hepatectomy. Patients were identified from a prospective database and retrospectively reviewed. Results of different time periods were assessed and prognostic factors for a favourable outcome were determined. RESULTS: The perioperative morbidity and mortality was 24% (23 of 94) and 3% (3 of 94), respectively. The one-, three-, five- and ten-year survival for all patients in this series was 89%, 55%, 38% and 23%, respectively. In the univariate analysis, pT-stage of the primary, diameter of the largest metastases, surgical radicality, period of resection and distribution of metastases showed statistically significant influence on survival. The multivariate analysis revealed only pT-stage of the primary tumour, surgical radicality and period of resection as independent prognostic factors. CONCLUSIONS: Repeat hepatectomy is a safe and effective treatment for recurrent liver metastases from colorectal cancer. Perioperative risk and long-term survival were similar when compared to the results obtained during the initial resection. Achieving a curative resection is the most relevant prognostic factor for a favourable prognosis after repeat liver resection.