CAJ | 학술논문

目的比较肝硬化患者和非肝硬化患者的单个小肝细胞癌(长径≤5 cm)手术切除疗效,探讨肝硬化对单个小肝细胞癌切除术后复发和患者长期生存的影响.方法采用回顾性研究方法,将2001年4月至2009年10月在我院肝脏外科中心接受肝切除术的单个小肝细胞癌患者共256例分为非肝硬化组(44例)和肝硬化组(212例),比较两组患者的无瘤生存率和总体生存率.男性227例,女性29例；年龄14 ～ 79岁,中位年龄49岁.224例(87.5％)患者合并乙型肝炎,241例(94.1％)患者术前肝功能为Child A级.采用单因素和多因素分析探讨单个小肝细胞癌患者肝切除术后的预后因素.结果非肝硬化组患者的1、3、5年无瘤生存率和总体生存率分别为93.0％、85.3％、68.5％和100％、92.5％、92.5％,肝硬化组患者的1、3、5年无瘤生存率和总体生存率分别为81.1％、58.6％、45.0％和93.8％、78.7％、67.8％.非肝硬化组患者的无瘤生存率和总体生存率优于肝硬化组(x2=8.756,P=0.003；x2=8.603,P=0.003).血管侵犯、肿瘤中低分化、无肿瘤包膜和肝硬化是影响单个小肝细胞癌患者肝切除术后复发的独立危险因素,亦是影响患者术后长期生存的独立危险因素.结论除血管侵犯、肿瘤中低分化、无肿瘤包膜等肿瘤生物学因素外,肝硬化亦是影响单个小肝细胞癌切除术后患者长期生存的重要不良预后因素.肝硬化患者肝切除术后的长期疗效劣于非肝硬化患者.
목적 비교간경화환자화비간경화환자적단개소간세포암(장경≤5 cm)수술절제료효,탐토간경화대단개소간세포암절제술후복발화환자장기생존적영향.방법 채용회고성연구방법,장2001년4월지2009년10월재아원간장외과중심접수간절제술적단개소간세포암환자공256례분위비간경화조(44례)화간경화조(212례),비교량조환자적무류생존솔화총체생존솔.남성227례,녀성29례；년령14 ～ 79세,중위년령49세.224례(87.5％)환자합병을형간염,241례(94.1％)환자술전간공능위Child A급.채용단인소화다인소분석탐토단개소간세포암환자간절제술후적예후인소.결과 비간경화조환자적1、3、5년무류생존솔화총체생존솔분별위93.0％、85.3％、68.5％화100％、92.5％、92.5％,간경화조환자적1、3、5년무류생존솔화총체생존솔분별위81.1％、58.6％、45.0％화93.8％、78.7％、67.8％.비간경화조환자적무류생존솔화총체생존솔우우간경화조(x2=8.756,P=0.003；x2=8.603,P=0.003).혈관침범、종류중저분화、무종류포막화간경화시영향단개소간세포암환자간절제술후복발적독립위험인소,역시영향환자술후장기생존적독립위험인소.결론 제혈관침범、종류중저분화、무종류포막등종류생물학인소외,간경화역시영향단개소간세포암절제술후환자장기생존적중요불량예후인소.간경화환자간절제술후적장기료효렬우비간경화환자.
Objectives To compare the outcomes after liver resection for a single small hepatocellular carcinoma (HCC) ( ≤ 5 cm) between non-cirrhotic patients and cirrhotic patients,and to explore the influence of liver cirrhosis on recurrence and overall survival after liver resection in patients with a single small HCC.Methods A consecutive series of 256 patients with a single small HCC undergoing liver resection from April 2001 to October 2009 was retrospectively reviewed. Among the 256 patients,227 patients were male,and 29 were female.The medium age was 49 years (ranged,14-79 years );224 (87.5％) patients were positive for hepatitis B surface antigen,241 (94.1％ ) patients were with preoperative liver function of Child-Pugh grade A.The entire cohort were divided into non-cirrhosis group (n =44) and cirrhosis group (n =212).Univariate analysis and then multivariate analysis were performed to determine the prognostic factors of recurrence and overall survival after liver resection for all patients.Results The 1-,3-,5-year recurrence-free survival rates after liver resection were 93.0％,85.3％,and 68.5％,respectively,in non-cirrhosis group,while 81.1％,58.6％,and 45.0％,respectively,in cirrhosis group.The 1-,3-,5-year overall survival rates after liver resection were 100％,92.5％,and 92.5％,respectively,in non-cirrhosis group,while 93.8％,78.7％,and 67.8％,respectively,in cirrhosis group. Both the recurrence-free survival and overall survival of non-cirrhosis group were significantly better than those of cirrhosis group ( x2 =8.756,P =0.003 ; x2 =8.603,P =0.003 ).Cirrhosis, absence of tumor capsule, presence of microvascular invasion and moderate/poor tumor differentiation were the independent adverse prognostic factors for recurrence-free survival and overall survival in patients with a single small HCC after liver resection.Conclusions Cirrhosis is an important adverse prognostic factor for long-term survival in patients with a single small HCC after liver resection. Liver resection resulted in much worse survival for cirrhotic patients compared to non-cirrhotic patients.