中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2011年
9期
784-788
,共5页
吴力群%邱法波%张顺%张斌%郭卫东%曹景玉%王祖森%胡维昱%韩冰%杨金镛%崔自介
吳力群%邱法波%張順%張斌%郭衛東%曹景玉%王祖森%鬍維昱%韓冰%楊金鏞%崔自介
오력군%구법파%장순%장빈%곽위동%조경옥%왕조삼%호유욱%한빙%양금용%최자개
癌%肝细胞%肝切除术%复发%预后
癌%肝細胞%肝切除術%複髮%預後
암%간세포%간절제술%복발%예후
Carcinoma,hepatocellular%Hepatectomy%Recurrence%Prognosis
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.
目的 探討影響原髮性肝細胞癌(HCC)患者肝切除術後短期複髮的危險因素.方法 迴顧性分析1997年1月至2008年12月接受肝切除術的502例HCC患者術後1～2箇月的評估結果與無瘤生存率和總體生存率的關繫.其中男性419例,女性83例,年齡14～82歲,平均54歲.結果 綜閤術中所見、病理學檢查、隨訪和術後2箇月評估的結果,顯示術中肉眼可見血管癌栓、姑息切除、切緣病理暘性、區域淋巴結轉移、術後血清甲胎蛋白(AFP)持續暘性、術後1箇月經導管肝動脈化療栓塞術(TACE)腫瘤血管染色併在1箇月後肝髒CT掃描相應區域有碘油沉積(TACE暘性)和術後1箇月肺轉移是短期複髮的危險因素,其中位無瘤生存時間＜6箇月.高危組(n=106)的1、2、5年總體生存率為52%、25%、8%,無瘤生存率為22%、9%、3%;非高危組(n=396)的1、2、5、10年總體生存率為97%、85%、56%、35%,無瘤生存率為84%、67%、42%、31%.高危組患者大多數為大肝癌、分化程度較差、腫瘤侵及肝包膜和伴有衛星竈者,TNM分期大多數處于Ⅲ、Ⅳ期.結論 術中肉眼可見血管癌栓、姑息切除、切緣病理暘性、區域淋巴結癌轉移、術後血清AFP值持續暘性、術後TACE暘性和術後1箇月肺轉移是HCC肝切除患者短期複髮的危險因素,具有這些危險因素之一時意味著腫瘤殘留,應採取針對性的治療措施以達到消滅腫瘤、延長總體生存期的目的.
목적 탐토영향원발성간세포암(HCC)환자간절제술후단기복발적위험인소.방법 회고성분석1997년1월지2008년12월접수간절제술적502례HCC환자술후1～2개월적평고결과여무류생존솔화총체생존솔적관계.기중남성419례,녀성83례,년령14～82세,평균54세.결과 종합술중소견、병이학검사、수방화술후2개월평고적결과,현시술중육안가견혈관암전、고식절제、절연병리양성、구역림파결전이、술후혈청갑태단백(AFP)지속양성、술후1개월경도관간동맥화료전새술(TACE)종류혈관염색병재1개월후간장CT소묘상응구역유전유침적(TACE양성)화술후1개월폐전이시단기복발적위험인소,기중위무류생존시간＜6개월.고위조(n=106)적1、2、5년총체생존솔위52%、25%、8%,무류생존솔위22%、9%、3%;비고위조(n=396)적1、2、5、10년총체생존솔위97%、85%、56%、35%,무류생존솔위84%、67%、42%、31%.고위조환자대다수위대간암、분화정도교차、종류침급간포막화반유위성조자,TNM분기대다수처우Ⅲ、Ⅳ기.결론 술중육안가견혈관암전、고식절제、절연병리양성、구역림파결암전이、술후혈청AFP치지속양성、술후TACE양성화술후1개월폐전이시HCC간절제환자단기복발적위험인소,구유저사위험인소지일시의미착종류잔류,응채취침대성적치료조시이체도소멸종류、연장총체생존기적목적.
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.
