原发性肝细胞癌肝切除术后短期复发的危险因素

目的 探讨影响原发性肝细胞癌(HCC)患者肝切除术后短期复发的危险因素.方法 回顾性分析1997年1月至2008年12月接受肝切除术的502例HCC患者术后1～2个月的评估结果与无瘤生存率和总体生存率的关系.其中男性419例,女性83例,年龄14～82岁,平均54岁.结果 综合术中所见、病理学检查、随访和术后2个月评估的结果,显示术中肉眼可见血管癌栓、姑息切除、切缘病理阳性、区域淋巴结转移、术后血清甲胎蛋白(AFP)持续阳性、术后1个月经导管肝动脉化疗栓塞术(TACE)肿瘤血管染色并在1个月后肝脏CT扫描相应区域有碘油沉积(TACE阳性)和术后1个月肺转移是短期复发的危险因素,其中位无瘤生存时间＜6个月.高危组(n=106)的1、2、5年总体生存率为52%、25%、8%,无瘤生存率为22%、9%、3%;非高危组(n=396)的1、2、5、10年总体生存率为97%、85%、56%、35%,无瘤生存率为84%、67%、42%、31%.高危组患者大多数为大肝癌、分化程度较差、肿瘤侵及肝包膜和伴有卫星灶者,TNM分期大多数处于Ⅲ、Ⅳ期.结论 术中肉眼可见血管癌栓、姑息切除、切缘病理阳性、区域淋巴结癌转移、术后血清AFP值持续阳性、术后TACE阳性和术后1个月肺转移是HCC肝切除患者短期复发的危险因素,具有这些危险因素之一时意味着肿瘤残留,应采取针对性的治疗措施以达到消灭肿瘤、延长总体生存期的目的.

Abstract：

Objective To analyze the high risk factors for tumor recurrence in short term after hepatectomy for the patients with primary hepatocellular carcinoma (HCC). Methods Five hundreds and two patients with primary HCC underwent hepatectomy were included from January 1997 to December 2008.Among these patients,males were 419 cases and females were 83 cases. The age was 14 to 82 years (average age 54 years). The results of evaluation on 2 months after resection and tumor recurrence and survival were analyzed. Results According to the operative and pathologic findings and the evaluation on 2 months after hepatectomy, the patients with vascular invasion, palliation resection,cutting edge pathologic residual tumor,lymph notes metastasis,serum AFP level continuing higher after resection or (and) positive TACE (tumor dyeing on TACE within 1 month and a deposit of lipiodol on CT scan) were high risk factors (high-risk group, 106 cases,21.1%) ,the recurrence-free survival was 22% ,9% and 3% (1,2 and 5 year) and overall survival was 52% , 25% and 8%. On the non-high risk group patients, the recurrence-free survival was 84% ,67%, 42% and 31% (1,2, and 5 year) and overall survival was 97% ,85%, 56% and 35%. The bigger tumor,poor differentiation,tumor invading to liver capsule, satellite focus and TNM Ⅲ-Ⅳ stage in high-risk groups were more significantly than that in non-high-risk groups. Conclusion The vascular invasion, palliation resection,cutting edge pathologic residual tumor, lymph notes metastasis, serum AFP level continuing higher or (and) positive TACE within 2 months after resection are high risk factors for HCC patients in short term after hepatectomy,which mean tumor remnant.

Evaluation on short term after hepatectomy for the patients with primary hepatocellular carcinoma

Objective To analyze the high risk factors for tumor recurrence in short term after hepatectomy for the patients with primary hepatocellular carcinoma (HCC). Methods Five hundreds and two patients with primary HCC underwent hepatectomy were included from January 1997 to December 2008.Among these patients,males were 419 cases and females were 83 cases. The age was 14 to 82 years (average age 54 years). The results of evaluation on 2 months after resection and tumor recurrence and survival were analyzed. Results According to the operative and pathologic findings and the evaluation on 2 months after hepatectomy, the patients with vascular invasion, palliation resection,cutting edge pathologic residual tumor,lymph notes metastasis,serum AFP level continuing higher after resection or (and) positive TACE (tumor dyeing on TACE within 1 month and a deposit of lipiodol on CT scan) were high risk factors (high-risk group, 106 cases,21.1%) ,the recurrence-free survival was 22% ,9% and 3% (1,2 and 5 year) and overall survival was 52% , 25% and 8%. On the non-high risk group patients, the recurrence-free survival was 84% ,67%, 42% and 31% (1,2, and 5 year) and overall survival was 97% ,85%, 56% and 35%. The bigger tumor,poor differentiation,tumor invading to liver capsule, satellite focus and TNM Ⅲ-Ⅳ stage in high-risk groups were more significantly than that in non-high-risk groups. Conclusion The vascular invasion, palliation resection,cutting edge pathologic residual tumor, lymph notes metastasis, serum AFP level continuing higher or (and) positive TACE within 2 months after resection are high risk factors for HCC patients in short term after hepatectomy,which mean tumor remnant.