摘要
目的探讨外生型肝癌(PHCC)的临床病理特点、外科治疗方式、手术远期预后及其影响因素。方法采用回顾性队列研究的方法,收集东方肝胆外科医院肝外五科于2011年1月至2017年12月期间行根治性肝癌切除术的65例PHCC患者的临床资料及随访数据,按照肿瘤所在位置分为两类:膈面生长型PHCC组(27例)和脏面生长型PHCC组(38例)。对两组患者的基线特征、肿瘤病理特征、围手术期结果和远期预后进行对比研究。结果与膈面生长型PHCC组相比,脏面生长型PHCC组具有更大的肿瘤直径(9.8 vs6.2 cm,P=0.048),更可能合并破裂出血(31.6%vs 11.1%, P=0.046)和伴有微血管侵犯(71.1%vs 44.4%,P=0.031)。两组患者均未出现围手术期死亡,膈面和脏面生长型PHCC组术后并发症发生率分别为25.9%和31.6%,不存在统计学差异(P> 0.05)。在远期预后方面,该65例患者的1、3、5年总生存率(OS)和无复发生存率(RFS)分别为82.6%、51.5%、41.6%和78.3%、60.3%、35.1%。膈面生长型PHCC组的1、3、5年OS和RFS分别为88.1%、64.0%、47.4%和85.0%、55.0%、45.9%,显著高于脏面生长型PHCC组的78.7%、42.7%、37.4%和73.4%、33.8%、30.1%,两组之间的差异具有统计学意义(P=0.031,P=0.042)。Cox多因素回归分析证实,合并肝硬化、Child-Pugh B级、脏面生长型PHCC、合并破裂出血、合并大血管侵犯是影响PHCC患者OS的独立危险因素;此外,脏面生长型PHCC、合并破裂出血、合并微血管侵犯、合并大血管侵犯是影响PHCC患者RFS的独立危险因素。结论 PHCC是一类特殊类型的HCC,肿瘤体积较大,手术切除是主要根治性手段,术后5年生存率可达到40%以上;膈面生长型PHCC的远期预后优于脏面生长型PHCC,肿瘤生长部位是影响PHCC患者OS和RFS的独立危险因素。
Objective To evaluate the pathological features, surgical procedures, lone-term postoperative prognosis and relevant risk factors of pedunculated hepatocellular carcinoma （PHCC）. Methods By retrospective cohort study, medical data of 65 PHCC patients undergoing curative resection in the Department of 5th Hepatic Surgery of Eastern Hepatobiliary Surgery Hospital from Jan. 2011 to Dec. 2017 was collected and analyzed. According to the location and growth pattern of PHCC, patients were divided into two groups： group with PHCC growing onto the diaphragmatic surface （n=27） and group with PHCC growing onto the visceral surface （n=38）. The baseline characteristics, pathological features, perioperative variable, and long-term postoperative prognosis were compared between the two groups. Results Compared with the group with PHCC growing onto the diaphragmatic surface, group with PHCC growing onto the visceral surface had larger tumor diameter （9.8 vs 6.2 cm, P=0.048）, and was more likely to undergo tumor rupture and hemorrhage （31.6% vs 11.1%, P=0.046）,meanwhile, the incidence of microscopic vascular invasion was also higher （71.1% vs 44.4%, P=0.031）, the difference was statistically significant （P〈0.05）. There was no perioperative mortality, and the incidence of postoperative complications was 25.9% in group with PHCC located on diaphragmatic surface the and 31.6% in group with PHCC located on visceral surface, there was no statistical difference （P〉0.05）. As to the long-term prognosis, The 1-, 3- and 5-year OS and RFS rates for the 65 PHCCs were 82.6%, 51.5%, 41.6% and 78.3%, 60.3%, 35.1%, respectively. The 1-, 3- and 5-year OS and RFS rates for group PHCC growing onto the diaphragmatic surface were 88.1%, 64.0%, 47.4% and 85.0%, 55.0%, 45.9%, respectively, signifcantly superior than the corresponding rates for group with PHCC growing onto the visceral surface with 78.7%, 42.7%, 37.4% and 73.4%, 33.8%, 30.1% （P=0.031 and 0.042,respectively）. On multivariable Cox-regression
作者
李镇利
严文韬
权冰
卢军华
杨田
吴孟超
LI Zhen-li;YAN Wen-tao;QUAN Bing;LU Jun-hua;YANG Tian;WU Meng-chao(Department of Hepatobiliary Surgery,Eastern Hepatobiliary Surgery Hospital of Second Military Medical University,Shanghai 200438,China;Department of Clinical Medicine,the Second Military Medical University,Shanghai 200433,China)
出处
《肝胆胰外科杂志》
CAS
2018年第6期441-447,共7页
Journal of Hepatopancreatobiliary Surgery
基金
国家自然科学基金项目(81472284
81672699)
上海市浦江人才计划(16PJD004)
关键词
癌
肝细胞
外生型肝癌
肝切除术
复发
总生存率
无瘤生存率
hepatocellular carcinoma
pedunculated hepatocellular carcinoma
hepatectomy
recurrence
overall survival rate
recurrence-free survival rate
