肝癌切除术后早/晚期复发的危险因素与治疗

目的 探讨影响原发性肝癌根治性切除术后早／晚期复发和预后的危险因素以及复发后的最佳治疗方式。方法 回顾性分析1997年1月至2002年12月我院收治的169例经病理证实为肝细胞性肝癌（HCC）根治性切除的病例，经随访2年以上，选择18项临床、病理及治疗等指标分析对早／晚复发的影响。结果 全组有76例复发，复发率44．6％，早期复发（≤12个月）49例，晚期复发（〉12个月）27例。AFP和血管侵犯是早期复发的危险因素，而肝硬化则是晚期复发的惟一危险因素。早期复发的1，3年生存率分别为69．3％和14．3％；晚期复发相应的生存率分别为100％和29．6％。尽管复发后的治疗方式大致相同，但复发病例中经再次切除和肝移植治疗组的1，3年生存率分别为94．7％和52．6％，而非手术治疗组的相应的生存率分别为71．9％和7．1％。结论 辨别病例存在的危险因素对于选择手术病例与术后辅助治疗有积极的意义。对于复发的病例，采取适当的治疗措施将明显延长生存期，取得较好的疗效。肝移植对于肝癌复发的治疗值得进一步探讨。

Different risk factors and therapy for early and late recurrence after resection of hepatocellular carcinoma

Objective To investigate the risk factors for recurrence after resection of hepatocel- lular carcinoma(HCC)and explore effective methods for treatment of the recurrence.Methods A to- tal of 169 patients receiving radical resection of HCC in our hospital from January 1997 to December 2002 were enrolled in this study to review the clinical characteristics,histopathological features and treatment.Eighteen parameters contributing to the recurrence were analyzed.Results Seventy-six patients(44.6%)had recurrence.Of the 76 patients,52 had early recurrence and 24 had the late one. AFP and venous invasion were risk factors for early recurrence while cirrhosis was only significant risk factor for the late recurrence.The overall 1-and 3-year survival rates were markedly lower after the early recurrence than after the late recurrence(69.3% vs.100%,14.3% vs.29.6%).The overall 1- and 3-year survival rates were 94.7% and 52.6% in the patients receiving surgical treatment again and 71.9% and 7.1% in those not receiving the surgical treatment.Conclusions The identification of sig- nificant risk factors for recurrence may not only improve the patient selection for HCC resection but al- so enable better selection of the patients for postoperative adjuvant therapy.Proper intervention was effective for the patients with HCC recurrence.Reoperation is better than other interventions in pro- longing the survival time after HCC recurrence.Whether liver transplantation is a substitutive opera- tive procedure for HCC recurrence needs to be further studied.