Prognostic factors and survival after hepatic resection for hepatocellular carcinoma without cirrhosis

BACKGROUND: Detailed follow-up of patients with chronic hepatitis has resulted in increased diagnosis of hepatocellular carcinoma (HCC) in patients without cirrhosis. Despite numerous studies on hepatic resection, the prognostic factors for intrahepatic recurrence and survival are not well known for patients with HCC without cirrhosis. METHODS: Among 349 patients with HCC treated in the past 13 years, cirrhosis was absent in 126 patients (36 per cent). Curative hepatic resection was carried out in 100 (79 per cent) of these patients. Risk factors for intrahepatic recurrence and prognostic factors for survival were evaluated by univariate and multivariate analyses. RESULTS: Postoperative morbidity and mortality rates were 22 and 3 per cent respectively. The 5- and 10-year disease-free and overall survival rates were 31 and 50 per cent, and 22 and 47 per cent respectively. Blood loss, surgical resection margin, intrahepatic metastasis, portal vein invasion and extent of hepatic resection were independently associated with overall survival. However, the only risk factors for intrahepatic recurrence were portal vein invasion and hepatitis C virus (HCV) infection. The former was related to early recurrence while the latter was related to later recurrence. The 5-year disease-free survival rate was 58 per cent in patients with hepatitis B virus infection while it was 6 per cent in patients with HCV infection (P < 0.001). CONCLUSION: In the treatment of HCC without cirrhosis, major hepatectomy is advocated to prevent early recurrence. Liver transplantation may be required for patients with HCV infection.     

107例肝细胞肝癌切除术后预后因素分析

目的 探讨影响肝细胞肝癌切除术后的预后因素。方法 回顾性分析广西医科大学肿瘤医院2002年6月~2004年5月间107例肝细胞肝癌手术切除患者的临床资料,选择38项临床病理因素分析其对生存率的影响。Kaplain-Meier法计算生存率,单因素分析采用Log-rank检验,多因素分析采用Cox模型筛选出对肝细胞肝癌切除预后有影响的临床病理因素。结果 全组1、3、5年生存率为85.0%,53.3%,43.9%。单因素分析：术前GGT,术前肝功能Child-Pugh分级,术后ALB,术后TBIL,术后ALP,术后GGT,肿瘤最大直径,门静脉癌栓,术中失血情况,围手术期输血,术后是否复发以及手术是否根治切除等。多因素分析：术后ALB,术后ALP,门静脉癌栓,术后是否复发,手术是否根治切除与预后相关。结论 术后ALB,术后ALP,门静脉癌栓,术后复发,根治性切除是影响肝细胞肝癌术后生存期的独立预后因素。     

Prognostic factors and longterm survival after hepatic resection for hepatocellular carcinoma originating from noncirrhotic liver

BACKGROUND: The incidence of hepatocellular carcinoma (HCC) in cirrhotic and noncirrhotic liver is increasing in the world, probably because of the high prevalence of infections by hepatitis B and C viruses. Despite numerous publications on hepatic resection, prognostic factors for intrahepatic recurrence and survival are not well known for patients with HCC without cirrhosis. STUDY DESIGN: One hundred eight consecutive patients with HCC in noncirrhotic liver have been treated by hepatic resection in the past 18 years in our center. Clinical, biologic, and histopathologic parameters of these patients were collected. Risk factors for intrahepatic recurrence and prognostic factors for survival were evaluated by univariate and multivariate analyses. RESULTS: Postoperative morbidity and mortality rates were 23% and 6.5%, respectively. The 3- and 5-year disease-free and overall survival rates were 55% and 43%, and 43% and 29%, respectively. Blood transfusion, absence of tumor capsule, and daughter nodules were independently associated with overall survival. But the only risk factors for recurrence were blood transfusion, absence of tumor capsule, daughter nodules, and margin resection < 10 mm. CONCLUSIONS: In the treatment of HCC without cirrhosis, hepatectomy remains a safe and legitimate treatment, but longterm results are impaired by a high rate of early recurrence likely related to metastatic dissemination. Only histopathologic factors related to the tumor are predictive of recurrence and overall survival.     

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??Analysis of risk factors for early recurrence of primary hepatocellular carcinoma after radical hepatectomy HUANG Jin-qiu*, PENG Min-hao, ZOU Quan-qing, et al. *Department of Hepatobiliary Pancreatic Surgery, Nanhua Hospital Attached to University of South China, Hengyang421002,China Corresponding author: PENG Min-hao, E-mail: minhaopeng@yahoo.com.cn Abstract Objective To explore the risk factors for early recurrence of primary hepatocellular carcinoma after radical hepatectomy. Methods The clinical data of 145 cases of hepatocellular carcinoma performed radical hepatectomy from June 2000 to December 2002 at the First Affiliated Hospital of Guangxi Medical University were analyzed retrospectively. Sixteen factors involved in clinic, pathology and treatment were analyzed to determine their impact upon early recurrence of hepatocellular carcinoma. Results Fifty-seven cases underwent early recurrence within one year after hepatectomy. The survival rate of 1 and 3 years in early recurrence group was 36.8% and 3.5%, respectively. The survival rate of 1 and 3 years in control group (relapse one year after hepatectomy or relapse-free during follow-up) was 100% and 63.6%, respectively. The significant difference of survival rate exist between the two groups (χ2=139.9, P<0.001).The univariate analysis showed that age, liver cirrhosis, tumor diameter, multiple tumor, tumor capsule formation, tumor capsule invasion, portal vein tumor thrombus, hepatic vein tumor thrombus, microvessel invasion and tumor Edmond-Steiner grade were high risk factors for early recurrence of hepatocellular carcinoma after hepatectomy. Meanwhile, multivariate analysis indicated that tumor diameter, portal vein tumor thrombus, microvessel invasion and tumor capsule invasion were independent factors for early recurrence. Conclusion Recurrence after hepatectomy is one of main biology properties of hepatocellular carcinoma. Tumor diameter, portal vein tumor thrombus, microvessel invasion and tumor capsule invasion are main high risk factors for early recurrence. Identifing the high risk factors associated with early recurrence contributes to the grasp of operation indication and guidance of adjunctive therapy.     

原发性肝癌切除术后早期复发高危因素分析

目的 探讨影响原发性肝癌根治性切除术后早期复发的高危因素。方法 回顾性分析2000年6月至2002年12月广西医科大学第一附属医院经根治性手术切除的145例原发性肝癌的临床病理资料,选择16项临床、病理和治疗等指标分析其对早期复发的影响。结果 全组1年内早期复发57例,早期复发组的1年存活率为36.8％,3年存活率为3.5％,而对照组（1年后复发或随访期间无复发）1年和3年存活率分别为100％和63.6%,两组存活率差异有统计学意义（χ2=139.9, P<0.001）。单因素分析表明,年龄、肝硬化、肿瘤直径、多发肿瘤、肿瘤包膜形成、肿瘤包膜浸润、门静脉癌栓、肝静脉癌栓、微血管浸润和肿瘤Edmond-Steiner分级是影响肝癌早期复发的高危因素。多因素分析提示,肿瘤直径、门静脉癌栓、肿瘤微血管浸润和肿瘤包膜浸润是影响肝癌早期复发的独立因素。结论 术后复发是肝癌的一大生物学特性,肿瘤直径、门静脉癌栓、微血管浸润和肿瘤包膜浸润是影响肝癌早期复发的最主要危险因素。甄别肝癌切除术后早期复发的高危因素对于手术适应证的把握和术后的辅助治疗有指导性意义。     

Selection criteria for hepatectomy in patients with hepatocellular carcinoma and portal vein tumor thrombus

OBJECTIVE: To examine the usefulness of the authors' method involving preoperative transcatheter arterial chemoembolization followed by hepatectomy. SUMMARY BACKGROUND DATA: The presence of portal vein tumor thrombus in a patient with hepatocellular carcinoma is one of the most significant factors for a poor prognosis. No standard therapy has been established. METHODS: Forty-five of 455 patients with hepatocellular carcinoma (10%) from 1989 to 1998 were included in this study. These patients had gross portal vein tumor thrombus but no distant metastases. The 23 patients (50%) who had indications for surgery received preoperative transcatheter arterial chemoembolization: 18 underwent hepatic resection and 5 underwent ligation of the hepatic artery or portal vein on laparotomy. Among the remaining 22 patients who did not have indications for hepatectomy, 10 received regional chemotherapy and 12 underwent transcatheter arterial chemoembolization. RESULTS: The mean duration of survival was 3.4 +/- 2.7 years in the 18 patients who received transcatheter arterial chemoembolization and hepatectomy and 0.36 +/- 0.26 years in the 27 patients who did not receive hepatectomy. The survival rate of the 18 patients who received hepatic resection with preoperative transcatheter arterial chemoembolization was 82% at 1 year, 42% at 3 years, and 42% at 5 years. Portal trunk occlusion by tumor thrombus, three or more primary nodules, an indocyanine green retention rate at 15 minutes of 20% or worse, and therapeutic choice other than hepatectomy were significant predictors of a poor prognosis on univariate analysis. Hepatectomy was the only factor that was significant on multivariate analysis. CONCLUSIONS: Patients may enjoy long-term survival if they receive hepatectomy with preoperative transcatheter arterial chemoembolization, when the number of primary nodules is no more than two, the portal trunk is not occluded by tumor thrombus, and the indocyanine green retention rate at 15 minutes is better than 20%.     

肝细胞癌切除术后预后因素分析

目的探索影响肝细胞肝癌手术预后的因素。方法回顾性分析2000～2005年76例经病理证实的肝细胞肝癌手术切除患者,选择16项临床、病理学因素,分析其对生存率的影响。结果全组1,3,5年生存率分别为85.53%,48.05%,14.96%。60例获得根治者1,3,5年生存率分别为100%,58.93%和18.35%。影响预后的单因素为:肿瘤根治程度、肝癌结节数目、肝功能分级、肿瘤分期、门脉癌栓、术前血清胆红素、术前白蛋白水平。多因素分析表明:术前肝功能Child-Pugh分级、肿瘤结节数目、门脉癌栓和肿瘤根治程度与生存率有显著相关性。结论肿瘤结节数目、门脉癌栓、术前肝功能分级、肿瘤根治程度是影响肝细胞肝癌术后的高风险因素。     

Intrahepatic dissemination of hepatocellular carcinoma after local ablation therapy

Background/Purpose  We aimed to clarify the histological features of and risk factors for intrahepatic dissemination after local ablation therapy (LAT) for hepatocellular carcinoma (HCC). Methods  Between April 1992 and December 2005, 192 HCC patients underwent hepatic resection at our department, among whom were 17 patients who had local recurrences after LAT. Eight of these 17 patients had intrahepatic dissemination. The clinical and histological characteristics of these 8 surgically treated patients with intrahepatic dissemination were investigated. Results  Histologically, numerous intrahepatic metastases were observed, mainly in the same section as the treated tumor, together with main or sectional portal vein tumor thrombi. Before the ablation therapy, the average tumor diameter was 2.1 cm, and 62.5% of the tumors were adjacent to the main or sectional portal vein. In terms of therapeutic factors, 25% of the patients had a prior needle biopsy and 62.5% had insufficient safety margins. Conclusions  LAT for HCCs (even those less than 3 cm in diameter) adjacent less than 5 mm to the main or sectional portal vein possibly promotes intrahepatic dissemination.     

An appraisal of liver and portal vein resection for hepatocellular carcinoma with tumor thrombi extending to portal bifurcation

BACKGROUND: The role of surgical resection for hepatocellular carcinoma with tumor thrombi involving the major portal vein is controversial because of a high operative risk and poor prognosis. Previously, a resection was performed only when the tumor thrombi were limited to the first branch of the portal vein without extension to the portal bifurcation. HYPOTHESIS: Concomitant liver and portal vein resection may be beneficial in patients with hepatocellular carcinoma with tumor thrombi extending to portal bifurcation. DESIGN: Retrospective review. SETTING: University hospital, tertiary referral center. PATIENTS: Among 368 patients with hepatocellular carcinoma who underwent a curative resection, portal vein involvement occurred in 112 patients. Fifteen of the 112 patients underwent a concomitant liver and portal vein resection owing to extension of tumor thrombi to the portal bifurcation (group 1). The remaining 97 patients did not need portal vein resection (group 2). INTERVENTION: Surgical indications, procedures, and results of pathological examination of resected specimens were assessed in patients in group 1. The clinicopathological characteristics, operative morbidity and mortality, and operative results were compared between the 2 groups. MAIN OUTCOME MEASURES: Disease-free and actuarial survival rates. RESULTS: Intramural tumor infiltration was found at the site of thrombi adhesion to the portal vein cuff in 11 of 15 patients in group 1. Owing to patient selection bias, patients in group 1 were significantly younger and had better liver function and greater resected liver weight. The operative time, postoperative hospitalization, operative blood loss, amount of blood transfusion, and operative morbidity and mortality did not differ significantly between the 2 groups. The 5-year disease-free survival rates of groups 1 and 2 were 21.6% and 20.4% (P =.19), respectively, while the actuarial survival rates were 26. 4% and 28.5% (P =.33), respectively. CONCLUSION: Liver resection with partial resection of the portal vein is justified in selected patients with hepatocellular carcinoma with tumor thrombi extending to portal bifurcation.     

经门静脉化疗泵行门静脉造影CT在肝癌术后复查中的应用及其意义

目的探讨经门静脉化疗泵行门静脉造影CT(CTP)在肝癌切除术后复查中的应用方法和意义。方法 36例原发性肝癌行肝切除手术后经门静脉化疗泵行门静脉造影CT检查。结果全组病例CTP检查发现5例(13.9%)术后早期复发,CTP清晰地显示了肝内复发、转移病灶的形态及血供变化。结论经门静脉化疗泵行门静脉造影CT可作为监测肝癌术后早期复发转移的一种敏感方法 ,对于评价疗效及早期发现病灶都有重要作用。     

经门静脉化疗泵行CT门静脉造影在肝癌术后复查中的应用及其意义

目的探讨经门静脉化疗泵行门静脉造影（CTP）在肝癌切除术后复查中的应用方法和意义。方法36例原发性肝癌行肝切除手术后经门静脉化疗泵行门静脉造影CT检查。结果全组病例CTP检查发现5例（13．9％）术后早期复发,CTP清晰地显示了肝内复发、转移病灶的形态及血供变化。结论经门静脉化疗泵行门静脉造影cT可作为监测肝癌术后早期复发转移的一种敏感方法。对于评价疗效及早期发现病灶都有重要作用。     

Nomograms predicting extra- and early intrahepatic recurrence after hepatic resection of hepatocellular carcinoma

BackgroundExtrahepatic recurrence and early intrahepatic recurrence of hepatocellular carcinoma after hepatic resection are indicative of poor prognoses. We aimed to develop nomograms to predict extrahepatic recurrence and early intrahepatic recurrence after hepatic resection.MethodsThe participants of this study were 1,206 patients who underwent initial and curative hepatic resection for hepatocellular carcinoma. Multivariate logistic regression analyses using the Akaike information criterion were used to construct nomograms to predict extrahepatic recurrence and early intrahepatic recurrence (within 1 year of surgery) at the first recurrence sites after hepatic resection. Performance of each nomogram was evaluated by calibration plots with bootstrapping.ResultsExtrahepatic recurrence was identified in 95 patients (7.9%) and early intrahepatic recurrence in 296 patients (24.5%). Three predictive factors, α-fetoprotein >200 ng/mL, tumor size (3–5 cm or >5 cm vs ≤3 cm), and image-diagnosed venous invasion by computed tomography, were adopted in the final model of the extrahepatic recurrence nomogram with a concordance index of 0.75. Tumor size and 2 additional predictors (ie, multiple tumors and image-diagnosed portal invasion) were adopted in the final model of the early intrahepatic recurrence nomogram with a concordance index of 0.67. The calibration plots showed good agreement between the nomogram predictions of extrahepatic recurrence and early intrahepatic recurrence and the actual observations of extrahepatic recurrence and early intrahepatic recurrence, respectively.ConclusionWe have developed reliable nomograms to predict extrahepatic recurrence and early intrahepatic recurrence of hepatocellular carcinoma after hepatic resection. These are useful for the diagnostic prediction of extrahepatic recurrence and early intrahepatic recurrence and could guide the surgeon’s selection of treatment strategies for hepatocellular carcinoma patients.     

Aggressive surgery for hepatocellular carcinoma in advanced stage and with recurrence]

Between July 1973 and September 1990, 160 patients with hepatocellular carcinoma underwent hepatic resection at Keio University Hospital. Hepatic resection was carried out for patients with advanced diseases as well as recurrence. The patients with advanced disease consisted of 5 patients with obstructive jaundice, 6 with tumor thrombi in the portal trunk, one with tumor thrombus in hepatic vein, inferior vena cava and right atrium, 8 with satellite nodules in both lobes. Nine (45%) of these patients survived more than 2 years. Seven patients underwent removal of recurrent tumors: 4 in the remnant liver, one each at the left adrenal gland, lung and chest wall. Two patients lived longer than 2 years with relief of pain.     

Risk factors for intrahepatic recurrence after hepatectomy for hepatocellular carcinoma

Background

Long-term survival after hepatectomy for hepatocellular carcinoma is still poor because of tumor recurrence especially in the liver remnant. The risk factors for intrahepatic recurrence after liver resection are studied in our cohort of patients.

Methods

A retrospective analysis from a prospective database was performed on 76 consecutive successful hepatectomies for hepatocellular carcinoma.

Results

Twenty-two patients had intrahepatic recurrence. The following were not found to be risk factors for recurrence: age, sex, race, number of segments resected, and mean operating time. By using multivariate analysis, serum aspartate transaminase level, more than 1 hepatocellular carcinoma nodule, and presence of tumor thrombi were found to be significant risk factors.

Conclusion

Patients who with these risk factors should undergo close follow-up to detect recurrence early; treatment with reresection, chemoembolization, or radiofrequency ablation can be considered.     

Intrahepatic recurrences of hepatocellular carcinoma after hepatectomy: analysis based on tumor hemodynamics.

HYPOTHESIS: Surgical margin, i.e., the area of possible local intrahepatic metastasis, is controversial in hepatectomy for hepatocellular carcinoma. DESIGN: The blood drainage area of tumor was identified preoperatively by abdominal helical computed tomographic scan under hepatic arteriography and excised as surgical margin. The specimens were pathologically examined on the basis of the corresponding computed tomographic images. SETTING: University hospital. PATIENTS: From June 2, 1997, to April 24, 2000, 67 patients with hepatocellular carcinoma who underwent curative hepatic resection. MAIN OUTCOME MEASURE: Intrahepatic recurrence. RESULTS: Blood drainage area of tumor could be classified into the following types. The marginal type (drainage into the peritumorous area) was frequent (50 cases) and excised mostly by nonanatomic, limited resection. Portal vein type (drainage into the portal branches) was less common (12 cases) and resected mostly by anatomically systematic hepatectomy. The remaining 5 cases were of the hypovascular type and underwent limited resection. Multiple nodules were frequently found inside the drainage area (4 of 8 cases) and were moderate or poorly differentiated hepatocellular carcinoma, consistent with intrahepatic metastasis. Solitary nodules were mostly outside the drainage area (11 of 12 cases) and contained well-differentiated hepatocellular carcinoma (7 of 10 cases), suggesting multicentric carcinogenesis. Intrahepatic recurrences were commonly found in bilateral or contralateral lobes (17 of 19 cases) and divided into 2 groups with a few (< or =4) and multiple (> or =8) recurrent nodules. CONCLUSIONS: Surgical margin varied according to tumor hemodynamics. Tumor recurrences may result not only from multicentric carcinogenesis but also from intrahepatic metastasis via systemic circulation.     

Surgical results for hepatocellular carcinoma with macroscopic portal vein tumor thrombosis

Background: The longterm results after liver resection for hepatocellular carcinoma with macroscopic tumor thrombus of the portal vein are unclear.

Study Design: The records of 47 HCC patients with tumor thrombus in the segmental portal branch (n = 33) and the first portal branch or portal vein trunk (n = 14) were reviewed in this study. Survival rates of the patients were calculated with regard to 14 clinicopathologic variables. A log-rank analysis was performed to identify which variables predicted the prognosis.

Results: Overall 1-, 3-, and 5-year survival rates were 53.9%, 33.2%, and 23.9%, respectively. The indicators of a favorable prognosis included curative liver resection, tumor size less than 10 cm in diameter, and absence of intrahepatic metastases.

Conclusions: Liver resection should be considered a therapeutic option for hepatocellular carcinoma with macroscopic portal vein tumor thrombus when the tumor is small and curative liver resection can be expected.     

Liver resection for hepatocellular carcinoma on cirrhosis: univariate and multivariate analysis of risk factors for intrahepatic recurrence

OBJECTIVE: To evaluate prognostic factors that could affect disease-free survival and recurrence after liver resection for hepatocellular carcinoma (HCC) on cirrhosis. SUMMARY BACKGROUND DATA: Tumor recurrence is the main cause of poor survival after liver resection for HCC on cirrhosis. METHODS: Two hundred twenty-four liver resections for HCC on cirrhosis were retrospectively reviewed. Univariate and multivariate analyses were performed on several clinicopathologic variables to analyze factors affecting long-term outcome and intrahepatic recurrence. The relation between preoperative aminotransferase level and recurrence rate was evaluated in the overall group, and separately in HCV-positive and in HBsAg-positive patients. Median follow-up was 35.6 months. RESULTS: The 1-, 3-, and 5-year overall survival rates were 83%, 62.8%, and 42.5%, respectively. The 1-, 3-, and 5-year disease-free survival rates were 70.3%, 43%, and 27.4%, respectively. The 1-, 3-, and 5-year recurrence rates were 20.8%, 38.6%, and 54.4% respectively. Tumor recurrence appeared in 93 patients (41.5%) and was the main cause of death in 51 patients (56%). Number of nodules, tumor capsule, microvascular portal vein thrombosis, and preoperative serum aspartate aminotransferase (AST) level significantly affected disease-free survival and recurrence rates. On multivariate analysis, single nodules and preoperative AST level less than twice normal (2N) were related to a better 5-year disease-free survival and lower tumor recurrence. In particular, among HCV-positive patients the recurrence rate was strongly affected by the preoperative AST level. CONCLUSIONS: Child A patients with single nodules are the best candidates for liver resection. Tumor recurrence is strictly linked to the status of the underlying liver disease, and a preoperative AST level equal to 2N seems to be a sensitive cutoff among patients with different risks of recurrence. HCV-positive patients with AST levels above 2N have the highest risk for intrahepatic recurrence and should be monitored carefully or offered alternative treatments.     

原发性肝癌合并门静脉癌栓的外科治疗方式选择

目的探讨原发性肝癌(HCC)合并门静脉癌栓(TTPV)的外科治疗方式选择。方法对1990年1月至2003年1月期间收治的138例肝癌合并门静脉癌栓患者的临床资料进行分析和总结。结果37例行保守姑息治疗患者1至8个月内死亡,平均生存时间3．9个月。101例患者行手术治疗,其中23例行单纯肝癌切除术,平均生存时问10．9个月;78例采取各种手术方式行肝癌切除加门静脉癌栓取栓术,平均生存时间26．8个月。其中52例术后采用了肝动脉和门静脉双插管微量泵灌注化疗,其1、3、5年生存率为96．2％、51．9％、11．5％,26例未行插管化疗,1、3、5年生存率为76．9％、23．1％、0％。结论手术治疗比保守治疗能相对延长肝癌合并门静脉癌栓患者的生存时间;手术在切除肝癌的同时应尽量使用各种方式取出门静脉癌栓;术后使用肝动脉和门静脉双插管微量泵灌注化疗可有效提高治疗效果。     

The clinical significance of lymph node metastases in patients undergoing surgery for hepatocellular carcinoma

The frequency of lymph node (LN) metastasis in patients undergoing surgery for hepatocellular carcinoma (HCC) has rarely been studied. We evaluated the clinicopathologic characteristics and outcomes of six patients with nodal metastases from HCC among a total of 504 patients who underwent hepatic resection for HCC in our department over a 16-year period. The nodal metastases were diagnosed preoperatively in two patients. The average diameter of the resected tumors was 7.8 cm and all were confirmed as poorly differentiated HCC. All of the six patients had intrahepatic metastatic nodules and five also had portal vein invasion. One patient underwent limited resection, and the other five underwent bisegmentectomy. All of the regional LNs were removed in one patient, while only enlarged LNs were removed in the other five. One patient died of postoperative liver failure and the others all died later of intrahepatic or nodal recurrence. Our findings suggest that the prognosis of patients with nodal metastasis from HCC is generally poor, even if hepatic resection with regional LN dissection is performed. Received: July 30, 1999 / Accepted: May 30, 2000     

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目的　探讨门静脉区域化疗对原发性肝癌完全切除术后的复发和转移的预防效果。方法　 1997年10月至 2 0 0 0年 10月间 ,广州医学院附属第二医院对 4 2例原发肝癌手术切除后分别行肝动脉 (18例 )或门静脉(2 4例 )区域预防性化疗。结果　两组间的术后 1、3、5年总生存率差异无显著意义 (P >0 0 5 ) ,门静脉化疗组的1、3年无瘤生存率显著高于肝动脉化疗组 (P <0 0 5 )。结论　术后门静脉区域预防性化疗可预防和延缓肝癌切除术后的复发和转移。