FACTORS AFFECTING LONG-TERM OUTCOME AFTER HEPATIC RESECTION FOR HEPATOCELLULAR-CARCINOMA

被引:262
作者
VAUTHEY, JN
KLIMSTRA, D
FRANCESCHI, D
TAO, Y
FORTNER, J
BLUMGART, L
BRENNAN, M
机构
[1] MEM SLOAN KETTERING CANC CTR,DEPT SURG,NEW YORK,NY 10021
[2] MEM SLOAN KETTERING CANC CTR,DEPT PATHOL,NEW YORK,NY 10021
[3] MEM SLOAN KETTERING CANC CTR,DEPT EPIDEMIOL & BIOSTAT,NEW YORK,NY 10021
关键词
D O I
10.1016/S0002-9610(99)80106-8
中图分类号
R61 [外科手术学];
学科分类号
摘要
BACKGROUND: Experience with hepatocellular carcinoma (HCC) is limited in the West and factors affecting outcome after resection are not clearly defined. METHODS: Between 1970 and 1999, 106 patients (including 74 Caucasians, 31 Orientals, and 1 black) underwent hepatic resection for HCC at Memorial Sloan-Kettering Cancer Center. Clinical and histopathologic factors of outcome were analyzed. RESULTS: Cirrhosis was present in 33% and 95% were Child-Pugh A. Operative mortality was 6%, 14% in cirrhotics versus 1% in non-cirrhotics (P = 0.013). Orientals had a higher prevalence of cirrhosis (68% versus 19%) (P <0.0001) and smaller tumors (mean 8.7 cm versus 11.0 cm) (P = 0.028) compared to Caucasians, Overall survival was 41% and 32% at 5 and 10 years, respectively. By univariate analysis, survival was greater in association with the following: absence of vascular invasion (69% versus 28%, P = 0.002); absence of symptoms (66% versus 38%, P = 0.014); solitary tumor (53% versus 28%, P = 0.014); negative margins (46% versus 21%, P = 0.022); small tumor (less than or equal to 5 cm) (75% versus 36%, P = 0.027); and presence of tumor capsule (69% versus 35%, P = 0.047). Ethnic origin, cirrhosis, necrosis and grade did not affect survival. By multivariate analysis, only vascular invasion predicted outcome (P = 0.0025, risk ratio 2.9). CONCLUSIONS: One third of patients resected for HCC can be expected to survive long-term. Except for a higher incidence of cirrhosis in Orientals, no major histopathologic or prognostic differences were noted between Orientals and Caucasians undergoing resection. Early cirrhosis (Child-Pugh A) did not adversely affect survival, Vascular invasion predicted long-term outcome.
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页码:28 / 35
页数:8
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