CAJ | 학술논문

目的探讨肝细胞癌(HCC)切除术后肝内复发的预后影响因素以及复发后治疗方式的选择.方法收集184例HCC切除术后肝内复发患者的临床病理资料,回顾性分析21项临床病理学因素以及复发后治疗方式对HCC患者肝内复发后生存期的影响.结果单因素分析结果表明,术前血清甲胎蛋白(AFP)水平较高(>100 ng/ml)、有微血管浸润、首次诊断复发时肿瘤的Child-Pugh分级为B或C级、有多个肝内复发肿瘤以及早期肝内复发(≤12个月)的患者预后不良.Cox多因素分析结果表明,首次诊断复发时肿瘤的Child-Pugh分级、复发肿瘤的数目和复发时间是影响HCC患者复发后生存期的独立危险因素.69例单个复发肿瘤患者中,经再次肝切除手术和局部消融治疗患者的复发后中位生存期分别为34和23个月,而经肝动脉插管化疗栓塞治疗和未进行治疗患者的复发后中位生存期分别为15和9个月,4种治疗方式患者的生存期差异有统计学意义(P<0.05).结论首次诊断复发时肿瘤的Child-Pugh分级为A级、单个复发肿瘤、复发时间较晚(>12个月)、经过再次肝癌切除手术或局部消融治疗的HCC肝内复发患者的预后较好.
목적 탐토간세포암(HCC)절제술후간내복발적예후영향인소이급복발후치료방식적선택.방법 수집184례HCC절제술후간내복발환자적림상병리자료,회고성분석21항림상병이학인소이급복발후치료방식대HCC환자간내복발후생존기적영향.결과 단인소분석결과 표명,술전혈청갑태단백(AFP)수평교고(>100 ng/ml)、유미혈관침윤、수차진단복발시종류적Child-Pugh분급위B혹C급、유다개간내복발종류이급조기간내복발(≤12개월)적환자예후불량.Cox다인소분석결과 표명,수차진단복발시종류적Child-Pugh분급、복발종류적수목화복발시간시영향HCC환자복발후생존기적독립위험인소.69례단개복발종류환자중,경재차간절제수술화국부소융치료환자적복발후중위생존기분별위34화23개월,이경간동맥삽관화료전새치료화미진행치료환자적복발후중위생존기분별위15화9개월,4충치료방식환자적생존기차이유통계학의의(P<0.05).결론 수차진단복발시종류적Child-Pugh분급위A급、단개복발종류、복발시간교만(>12개월)、경과재차간암절제수술혹국부소융치료적HCC간내복발환자적예후교호.
Objective To investigate the prognostic factors and treatment choice for intrahepatic recurrence after hepatectomy in patients with hepatocellular carcinoma (HCC). Methods Clinicopatholngical data of 184 HCC patients with intrahepatic recurrence after hepatectomy were collected. The influences of twenty one clinicopathological factors and treatment modalities on the survival after recurrence were retrospectively analyzed. Results Univariate analysis showed that preoperative serum alpha-fetoprotein (AFP) > 100 ng/ml, microscopic venous invasion, patients classified as Child-Pugh class B or C at diagnosis of recurrence, multiple recurrence feci and early recurrence ( ≤ 12 months) were poor prognostic factors. Cox multivariate analysis showed that Child-Pugh class at diagnosis of recurrence, number of recurrent foci and time to recurrence were independent risk factors for survival in patients with recurrence. Median survival after recurrence was 34 months, 23 months, 15 months and 9 months, respectively, in patients treated by repeated hepatectomy, local ablation therapy, transcatheter arterial chemoembolization (TACE) or non-treatment in 69 patients with solitary recurrence. There were statistically significant differences among these four groups ( P < 0.05). Conclusion classification of Child-Pngh class A at the first time of diagnosis, solitary recurrence, late recurrence ( > 12 months), and intrahepatic recurrence occurred after repeated hepatectomy or local ablation therapy are better prognostic factors in patients with HCC recurrence.