Abstract:

Effects of histological grading of liver cirrhosis on long-term outcomes of hepatectomy for small hepatocellular carcinoma        LIANG Bin-yong, DONG Ke-shuai, ZHANG Er-lei, et al. Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Corresponding author: HUANG Zhi-yong, E-mail：zyhuang@medmail.com.cn
Abstract    Objective    To investigate the effect of histological severity of liver cirrhosis on the prognosis of hepatectomy for patients with small hepatocellular carcinoma (HCC) and liver cirrhosis. Methods    A total of 500 patients with small HCC and liver cirrhosis underwent radical hepatectomy in Tongji Hospital of Huazhong University of Science and Technology from Aug 2001 to December 2015 were analyzed. The patients were divided into mild, moderate and severe cirrhosis group according to the Laennec histological sub-classification of liver cirrhosis. The recurrence-free survival rates and overall survival rates of each group were compared, and the prognostic factors were analyzed. Results    The 5-year recurrence-free survival and overall survival rates were 52.4%, 26.4%, 10.3%and 76.8%, 50.8%, 38.3%, respectively, in mild, moderate and severe cirrhosis group. With the increasing severity of liver cirrhosis, the recurrence-free survival rates and overall survival rates were decreased significantly. The difference was statistically significant (P<0.05). Multivariate analysis showed that the severity of cirrhosis, portal hypertension, tumor size, microvascular invasion, and tumor differentiation were the independent risk factors for postoperative recurrence and long-term survival in patients with small HCC and liver cirrhosis. Conclusion    The severity of cirrhosis is one of the independent risk factors for postoperative recurrence and long-term survival in patients with small HCC and liver cirrhosis. The severity of cirrhosis may play an important role in patient selection and prognosis for the patients with small HCC and liver cirrhosis.

Key words: cirrhosis, sub-classification, hepatocellular carcinoma, hepatectomy

摘要：

目的    探讨肝硬化组织学分级对小肝癌合并肝硬化病人肝切除术后长期疗效的影响。方法    选取2001年8月至2015年12月在华中科技大学同济医学院附属同济医院肝脏外科接受根治性切除术的小肝癌合并肝硬化病人共500例。根据肝硬化组织学改变严重程度的分级标准（Laennec分级标准），将病人分为轻度、中度和重度肝硬化3组，比较各组病人的无瘤存活率和总体存活率，并分析全组病人的预后影响因素。结果    轻度、中度、重度肝硬化组病人的5年无瘤存活率和总体存活率分别为52.4%、26.4%、10.3%和76.8%、50.8%、38.3%。随着肝硬化严重程度的增加，其无瘤存活率和总体存活率均显著降低，差异有统计学意义（P<0.05）。多因素分析结果显示，肝硬化组织学分级、门静脉高压症、肿瘤大小、微血管侵犯、肿瘤分化程度是影响小肝癌术后复发和长期生存的独立危险因素。结论    肝硬化组织学分级是影响小肝癌术后复发和长期生存的独立危险因素之一。肝硬化组织学分级对小肝癌合并肝硬化病人的治疗方式选择、判断预后可能具有重要的参考意义。

关键词: 肝硬化, 分级, 肝细胞癌, 肝切除术