肝癌根治性切除术后早期复发时限和模式的确定及其对预后的影响

目的:明确肝癌根治性切除术后早期复发的时限、模式及其对患者预后的影响。方法:回顾性分析166例于我院临床诊断为原发性肝癌并接受根治性切除手术患者的临床资料及随访结果。结果:至随访终点,共计120例患者发生肝癌复发,其中单纯肝内复发111例;患者术后1～5年逐年复发率分别为43.3%、25.2%、27.1%、24.3%、0%。术后1年内复发患者的生存率与1年之后复发患者相比差异有显著性(P<0.05);术后1年内复发以Ⅲ型(肿瘤肝内弥漫性复发)为主,而1年之后复发以Ⅰ型(切缘复发)和Ⅱ型(邻近肝段复发)为主,复发模式差异有显著性(P<0.05)。术后1年内复发患者中,Ⅰ型、Ⅱ型两组之间复发后生存率差异无显著性,Ⅲ型无3年存活者,复发后生存率与前两组比较差异存在显著性(P<0.01)。结论:肝癌根治性切除术后第1年肿瘤复发率最高、患者预后更差,确定早期复发的时限以术后1年为宜;早期复发的模式以肿瘤肝内弥漫性复发为主,是导致早期复发患者整体预后差的主要原因。

A clinical study on the recurrent time and type of HCC following radical resection of the tumor

Objective To compare the recurrent time and type in the patients with HCC underwent radical resection of the tumor and prognosis.Methods 166 subjects with HCC following radical resection in our hospital were enrolled in this study and the clinical data were reviewed.Results At the time of the final followup,120 patients recurred(intrahepatic recurrence in 111).The annual recurrence rate was 43.3%,25.2%,and 0% in the 1st,2nd and 5th postoperative year.Those patients(72)who were then classified as group 1.The remaining(48)were definited as group.There was significant difference in the cumulative survival between groups.Regarding the recurrence type,there were 42 cases with diffuse intrahepatic recurrence in group 1,while only 11 cases in group 2.There was also significant difference between the 2 groups.Conclusions The 1st postoperative year is very important for the recurrent patients after radical resection of the HCC,which accounts for the prognosis.And the mostly common type of ER is diffuse intrahepatic recurrence.