巨大肝癌手术切除治疗的远期疗效

背景与目的：巨大原发性肝癌(直径≥10cm)在临床上占有较大的比例,但关于其手术切除治疗的远期疗效报道较少。本研究探讨手术切除治疗巨大肝癌的远期疗效和预后影响因素。方法：回顾性分析我院1964年至1993年经手术切除的173例巨大肝癌患者的病例资料,根据随访结果计算生存率并作单因素及多因素分析。结果：术后3、5和10年累积生存率分别为31．9％、21．8％和8．3％;生存5年以上37例,生存10年以上8例;单因素分析结果表明预后影响因素为性别、术前肝功能Child-Pugh分级、术中肝硬化程度和是否根治性切除;多因素分析得出影响巨大肝癌切除术后远期疗效的独立预后因素为术中肝硬化程度和是否根治性切除。结论：巨大肝癌应积极争取手术切除治疗,术后能否长期生存取决于肝硬化程度和是否根治性切除。

Long-term prognosis after hepatic resection for huge primary liver cancer

BACKGROUND & OBJECTIVE: Primary liver cancer (PLC) larger than 10 cm in diameter is called huge PLC. Huge PLC accounts for a number of patients at the time of diagnosis in clinical practice. The outcome of resection in these patients has not been clearly demonstrated. This study was to evaluate the outcome and determined the prognostic factors affecting long term survival following hepatectomy for huge PLC. METHODS: One hundred and seventy three patients with huge PLC who underwent hepatectomy from 1964 to 1993 were followed up to January 2003 and reviewed retrospectively. The factors affecting long term survival were studied by univariate and multivariate analysis. RESULTS: The overall 3 , 5 , and 10 year survival rates were 31.9%, 21.8%, and 8.3%, respectively. Thirty seven patients survived more than 5 years and 8 patients survived more than 10 years. Univariate analysis showed that sex, Child Pugh classification, degree of coexisting cirrhosis and radical resection were significant prognostic factors. The Cox multivariate proportional hazard model indicated that independent prognostic factors for long term survival were degree of coexisting cirrhosis and radical resection. CONCLUSIONS: Hepatic resection for huge PLC offers the chance of long term survival. It should be used to treat patients with huge PLC at first choice. Degree of coexisting cirrhosis and radical resection were the only two prognostic factors for long term survival following hepatectomy for huge PLC.