CAJ | 학술논문

目的肝细胞癌(HCC)切除后生存>20年病例文献罕见报道.笔者报道HCC切除后生存20年以上的l临床和病理特点及远期随访资料.方法比较1961-1987年间长生存组(53例术后生存≥20年)和短生存组(343例术后生存<20年)的临床和病理资料,探讨进一步提高肝癌外科远期疗效的途径.结果随访至2007年3月,53例中36例(67.9%)仍无癌生存,3例(5.7%)因肝癌复发或转移死亡,6例(11.3%)因肝功能衰竭死亡,3例(5.7%)分别死于其他疾病,5例(9.4%)失访.5例青年病人术后已结婚生育,2例肝癌破裂出血者术后分别生存26年6个月(死于肝功能衰竭)、38年9个月(健在),最长1例术后生存43年2个月,该例曾于术后38年3个月复发,经治疗后又生存4年11个月(时年94岁).亚临床复发10例,其中再手术切除9例.复发与第一次手术间隔平均11年9个月.自第一次术后算起平均生存26年11个月.单结节肺转移3例并作再手术切除,复发与第一次手术间隔平均3年6个月,自第一次术后算起平均生存29年2个月.巨大肝癌综合治疗缩小后二期切除4例,自第一次术后算起平均生存22年10个月,均无癌生存.与短生存组比较,长生存组病人年龄较轻(P<0.05),无症状者较多(P<0.01)、γ-GTP值低(P<0.01)、合并肝硬化者少(P<0.01)、肿瘤直径≤5 cm者多(P<0.01)、肿瘤单结节者多(P<0.01)、肿瘤包膜完整者多(P<0.01)、门静脉有癌栓者少(P<0.01)、癌细胞分化程度好(P<0.05)、根治性切除者多(P<0.01).结论肝癌早期发现和根治性切除是获得长期生存的主要因素;术后长期终生随访极为重要;及早发现复发或转移并作再切除是进一步提高疗效的重要途径.
목적 간세포암(HCC)절제후생존>20년병예문헌한견보도.필자보도HCC절제후생존20년이상적l림상화병리특점급원기수방자료.방법 비교1961-1987년간장생존조(53례술후생존≥20년)화단생존조(343례술후생존<20년)적림상화병리자료,탐토진일보제고간암외과원기료효적도경.결과 수방지2007년3월,53례중36례(67.9%)잉무암생존,3례(5.7%)인간암복발혹전이사망,6례(11.3%)인간공능쇠갈사망,3례(5.7%)분별사우기타질병,5례(9.4%)실방.5례청년병인술후이결혼생육,2례간암파렬출혈자술후분별생존26년6개월(사우간공능쇠갈)、38년9개월(건재),최장1례술후생존43년2개월,해례증우술후38년3개월복발,경치료후우생존4년11개월(시년94세).아림상복발10례,기중재수술절제9례.복발여제일차수술간격평균11년9개월.자제일차술후산기평균생존26년11개월.단결절폐전이3례병작재수술절제,복발여제일차수술간격평균3년6개월,자제일차술후산기평균생존29년2개월.거대간암종합치료축소후이기절제4례,자제일차술후산기평균생존22년10개월,균무암생존.여단생존조비교,장생존조병인년령교경(P<0.05),무증상자교다(P<0.01)、γ-GTP치저(P<0.01)、합병간경화자소(P<0.01)、종류직경≤5 cm자다(P<0.01)、종류단결절자다(P<0.01)、종류포막완정자다(P<0.01)、문정맥유암전자소(P<0.01)、암세포분화정도호(P<0.05)、근치성절제자다(P<0.01).결론 간암조기발현화근치성절제시획득장기생존적주요인소;술후장기종생수방겁위중요;급조발현복발혹전이병작재절제시진일보제고료효적중요도경.
Objective To clarify the clinicopathological features of patients surviving≥20 years after resection for hepatoceUular carcinoma(HCC).Methods Between 1961 and 1987, a total of 396 patients underwent hepatic resection for HCC.Of the 396 patients, 53(13.4 %) survived ≥20 years and 343(86.6%) <20 years.A comparative study between the two groups was made.Results By March of 2007, 67.6%(36/53) of the patients were still alive and disease-free while 5.7% (3/53) of them died of tumor recurrence or metastasis, 11.3 % (6/537 died of liver failure, 5.70% (3/537 died of other disease, and 9.4% (5/53) were lost during follow-up.Two patients with intraperitoneal rup-tured HCC survived fro 26.6 years and 38.75 years, respectively.Five young patients got married af-ter resection and have had babies.The longest surviving time was 43 years and 2 months.Reresection for recurrence was done in 9 patients and the mean survival was 26 years and 11 months.Reresection for solitary pulmonary metastasis was performed in 3 patients and the mean survival was 29 years and 2 months.Downstaging followed by resection was performed in 4 patients, mean survival being 22 years and 10 months.In comparison with patients surviving <20 years, those surviving ≥20 years were significantly younger(P<0.05) and had a higher incidence of asymptomatic tumors (P<0.01), lower γ-glutanyl transpeptidase levels (P<0.01), lower incidence of liver cirrhosis (P<0.01) ; high-er percentage of smaller tumors (P<0.01), single nodule tumors (P<0.01) and well encapsulated tumors (P<0.01), lower incidence of tumor emboli in portal vein (P<0.01), better differentiation of tumor cells (P<0.05) and higher curative resection rate (P<0.01).Conclusions Early and cura-tive resection are important for improving long-term survival.Long-term follow-up after resection of HCC is very important, and should continue for the remainder of the patient's life.Reresection for re-currence and metastasis is an important approach to improve prognosis.