影响原发性肝癌根治术后近期和远期复发的临床病理因素

目的 :探讨根治性肝癌术后近期和远期复发因素 ,以期对高复发倾向人群抗复发提出针对性对策。方法 :回顾分析 1994年 5月～ 1998年 1月 16 2例根治性肝癌切除病例的临床资料 ,以影像学发现肿瘤复发及患者死亡或末次随访日期为截点确定无瘤生存时间 ,将术后复发病人分为近期复发 (≤ 2年 )、远期复发 (>2年 )及未复发 3组 ,确定复发危险因素。结果 :本组术后 1、 3、 5年无瘤生存率分别为 6 7. 1、 4 4 . 7及 2 5 . 5 %。与肿瘤近期复发相关因素为发现方式、肿瘤大小、血管癌栓、INM分期 ;与后期复发相关因素为有无肝硬化及其类型、肝功Child -Pugh分级和有无子瘤。结论 :根治性肝癌切除术后近期和远期复发的临床病理因素不同 ,及早发现小肝癌是预防近期复发的关键 ,兼顾术前肝功能可以对远期复发有预测作用

Clinicopathologic factors influencing the short-term and long-term recurrence of hepatocellular carcinoma

Objective:To explore the factors influencing the short-term and long-term recurrence of hepatocellular carcinoma(HCC)after radical operation.Methods:A retrospective survey was carried out in 162 patients undergoing radical resection of HCC between May 1994 and January 1998.After at least 5 years'follow-up,132 of 162 patients had recurrent HCC,who were divided into early(<2 years)and late(>2 years)recurrence groups.Disease-free survival rate was defined as the time relapsed from the date of image diagnosis and either the date of death or the date of the latest follow-up visit.All the follow-up ended in January 2003.Statistical analysis was done to evaluate the prognostic factors of recurrence.Results:The 1,3,5-year disease-free survival rates were 67.1%,44.7%and 25.5%,respectively.Results showed that the associated factors of early recurrence were as follows:the way by which a tumor was found,tumor size,venous invasion and advanced TNM stages,while cirrhosis type,Child-Pugh stage and satellite nodule were associated with late recurrence.Conclusion:Prognostic factors of the short-term recurrence and the long-term recurrence are different.Finding the small HCC as early as possible is the key point to prevent early recurrence;meanwhile,it may help to predict the late recurrence of HCC when the importance of liver function before operation is attached.