医学
肝细胞癌
内科学
胃肠病学
阶段(地层学)
肝切除术
癌
存活率
肝病学
六氯环己烷
米兰标准
肝移植
外科
肿瘤科
切除术
移植
生物
古生物学
作者
Tadatoshi Takayama,Masatoshi Makuuchi,Setsuo Hirohashi,Michiie Sakamoto,Junji Yamamoto,Kazuaki Shimada,Tomoo Kosuge,Shuichi Okada,Kenichi Takayasu,Susumu Yamasaki
出处
期刊:Hepatology
[Lippincott Williams & Wilkins]
日期:1998-11-01
卷期号:28 (5): 1241-1246
被引量:385
标识
DOI:10.1002/hep.510280511
摘要
Early hepatocellular carcinoma (HCC) has been defined as a well–differentiated cancer containing Glisson's triad, but it remains unknown whether this lesion is curable. We prospectively studied 70 patients (enrolled from 1,172 referrals between 1982 and 1991) who had a diagnosis of a single HCC 2 cm or less in diameter (Stage T1) and who underwent curative hepatectomy and long–term follow–up (range, 0.2 to 14.3 years). Patients were eligible for surgery if they had a tumor that met the diagnostic criteria for HCC and were in Child–Pugh class A (n = 59) or B (n = 11) status. Among the 70 patients, there was 1 operative death. Based on our typing system, the tumors were assigned as early HCC (n = 15), overt HCC (n = 52), and non–HCC tumor (n = 3). The rate of microscopic regional spread was lower in early HCCs than in overt HCCs (7% vs. 42%; P = .01). The early HCC group had a longer time to recurrence than did the overt HCC group (3.9 vs. 1.7 years; P < .001) and had no local recurrence. After a median follow–up of 6.3 years, both overall survival and recurrence–free survival in the early HCC group were significantly better than those in the overt HCC group ( P = .01; P = .001). In these two groups, the 5–year rates of overall survival were 93% and 54% ( P = .01), and those of recurrence–free survival were 47% and 16% ( P = .05), respectively; a significant survival benefit persisted over a decade (57% vs. 21%; P = .05). The early HCC group was at a lower risk of recurrence (relative risk, 0.31; 95% CI, 0.15 to 0.65; P = .002) and death (relative risk, 0.26; 95% CI, 0.09 to 0.73; P = .01) than was the overt HCC group. Early HCC is a distinct clinical entity with a high rate of surgical cure, thereby justifying its definition. It can be a lesion that corresponds to “Stage 0” cancer in other organs.
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