非解剖性肝切除治疗肝癌合并肝硬化病人的疗效和预后因素分析
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摘要
背景和目的:众多研究显示解剖性肝切除治疗肝癌获得了较好的临床效果。由于东方国家大多数肝癌病人都合并不同程度的肝硬化,解剖性肝切除的应用受到限制,特别是对于有严重肝硬化的病人。但是,非解剖型肝切除治疗肝癌合并肝硬化病人的临床效果鲜有报道。
方法:统计武汉同济医院于2003年1月到2006月12月期间,连续77例肝癌合并轻,中,重度肝硬化接受非解剖性肝切除的病人,分析其临床病理和手术相关资料,统计比较不同程度肝硬化病人的1-,2-,3-年生存率,分析影响预后的相关危险因素。
结果:总体累积1-,2-,3-年生存率分别为78%,68%, 56%,1-,2-,3-年无瘤生存率分别为66%,58%, 55%。围手术期死亡率为0,术后并发症发生率为24.7%。肿瘤直径小于5cm组1-,2-,3-年生存率分别为87.5%, 79.2%,75%,肿瘤直径大于等于5cm组1-,2-,3-年生存率分别为75.5%, 62.3%,47.2%,两组有显著性差异(P=0.002).轻度肝硬化组和重度肝硬化组1,2,3年生存率分别为85.7%,77.1%,74.3%和60.0%,53.3%,26.7% (P=0.003).单因素和多因素分析显示预后的独立危险因素为肿瘤直径大于等于5cm,肝硬化,和血管侵犯。
结论:对比解剖性肝切除,非解剖性肝切除治疗肝癌合并肝硬化病人同样可获得较好疗效,尤其是对于肿瘤直径小于5cm的病人。非解剖性肝切除术保留更多的正常肝实质,减少了术后并发症的发生,是治疗肝癌合并肝硬化的安全有效的手段。
BACKGROUND AND OBJECTIVE: It has been overwhelmingly reported that anatomic liver resection achieves the best clinical outcomes for treatment of hepatocellular carcinomas (HCC). As most of HCC patients in the east countries are associated with varied degrees of liver cirrhosis, however, the application of anatomic resection is therefore largely limited, especially in those with severe liver cirrhosis. However, The clinical outcomes of non-anatomic resection in patients with varied degree of cirrhosis are still lacking.
METHODS: Between January 2003 and December 2006, 77 consecutive HCC patients with mild, moderate or severe liver cirrhosis underwent non-anatomic liver resection in Tongji hospital. The clinicopathological and surgical characteristics, survivals of these patients with varied degree of cirrhosis were retrospectively evaluated and compared, and the prognostic factors were analyzed.
RESULTS: Cumulative 1, 2, 3-year overall survival rates of this cohort of patients were 78%,68%, 56%, and disease-free survival rates were 66%,58%, 55% respectively. The perioperative motility rate was zero, and mobility rate was 27%. The 1, 2, 3-year overall survival were 87.5%, 79.2% and 75% in the patients with tumor smaller than 5 cm, and 75.5%, 62.3% and 47.2% in the patients with tumor equal to or larger than 5 cm. There was a significant difference between the two groups (P=0.002). The 1, 2, 3-year overall survival were 85.7%, 77.1% and 74.3% in the patients with mild liver cirrhosis, and 60.0%, 53.3% and 26.7% in the patients with severe cirrhosis. There was a significant difference between the two groups (P=0.003). Multivariate and univariate analysis revealed that statistically significant independent factors for overall survival were liver cirrhosis, tumor diameter >=5cm and vascular invasion.
CONCLUSIONS: Non-anatomic liver resection for HCCs in patients with liver cirrhosis could yield comparable outcomes with anatomic resection, especially in those with tumors smaller than 5 cm. Non-anatomic resection preserves more liver parenchyma and therefore reduces postoperative complications. Non-anatomical resection is a safe and effective surgical strategy in treatment of HCC patients with liver cirrhosis.
方法:统计武汉同济医院于2003年1月到2006月12月期间,连续77例肝癌合并轻,中,重度肝硬化接受非解剖性肝切除的病人,分析其临床病理和手术相关资料,统计比较不同程度肝硬化病人的1-,2-,3-年生存率,分析影响预后的相关危险因素。
结果:总体累积1-,2-,3-年生存率分别为78%,68%, 56%,1-,2-,3-年无瘤生存率分别为66%,58%, 55%。围手术期死亡率为0,术后并发症发生率为24.7%。肿瘤直径小于5cm组1-,2-,3-年生存率分别为87.5%, 79.2%,75%,肿瘤直径大于等于5cm组1-,2-,3-年生存率分别为75.5%, 62.3%,47.2%,两组有显著性差异(P=0.002).轻度肝硬化组和重度肝硬化组1,2,3年生存率分别为85.7%,77.1%,74.3%和60.0%,53.3%,26.7% (P=0.003).单因素和多因素分析显示预后的独立危险因素为肿瘤直径大于等于5cm,肝硬化,和血管侵犯。
结论:对比解剖性肝切除,非解剖性肝切除治疗肝癌合并肝硬化病人同样可获得较好疗效,尤其是对于肿瘤直径小于5cm的病人。非解剖性肝切除术保留更多的正常肝实质,减少了术后并发症的发生,是治疗肝癌合并肝硬化的安全有效的手段。
BACKGROUND AND OBJECTIVE: It has been overwhelmingly reported that anatomic liver resection achieves the best clinical outcomes for treatment of hepatocellular carcinomas (HCC). As most of HCC patients in the east countries are associated with varied degrees of liver cirrhosis, however, the application of anatomic resection is therefore largely limited, especially in those with severe liver cirrhosis. However, The clinical outcomes of non-anatomic resection in patients with varied degree of cirrhosis are still lacking.
METHODS: Between January 2003 and December 2006, 77 consecutive HCC patients with mild, moderate or severe liver cirrhosis underwent non-anatomic liver resection in Tongji hospital. The clinicopathological and surgical characteristics, survivals of these patients with varied degree of cirrhosis were retrospectively evaluated and compared, and the prognostic factors were analyzed.
RESULTS: Cumulative 1, 2, 3-year overall survival rates of this cohort of patients were 78%,68%, 56%, and disease-free survival rates were 66%,58%, 55% respectively. The perioperative motility rate was zero, and mobility rate was 27%. The 1, 2, 3-year overall survival were 87.5%, 79.2% and 75% in the patients with tumor smaller than 5 cm, and 75.5%, 62.3% and 47.2% in the patients with tumor equal to or larger than 5 cm. There was a significant difference between the two groups (P=0.002). The 1, 2, 3-year overall survival were 85.7%, 77.1% and 74.3% in the patients with mild liver cirrhosis, and 60.0%, 53.3% and 26.7% in the patients with severe cirrhosis. There was a significant difference between the two groups (P=0.003). Multivariate and univariate analysis revealed that statistically significant independent factors for overall survival were liver cirrhosis, tumor diameter >=5cm and vascular invasion.
CONCLUSIONS: Non-anatomic liver resection for HCCs in patients with liver cirrhosis could yield comparable outcomes with anatomic resection, especially in those with tumors smaller than 5 cm. Non-anatomic resection preserves more liver parenchyma and therefore reduces postoperative complications. Non-anatomical resection is a safe and effective surgical strategy in treatment of HCC patients with liver cirrhosis.
引文
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