48例复发性肝细胞癌再次切除术后的疗效及预后因素分析

目的:分析复发性肝细胞癌行再次切除术后的疗效和影响预后的因素。方法:回顾性分析中山大学附属肿瘤医院和江西省人民医院1995年7 月至2003年7 月48例复发性肝细胞癌患者行再次肝切除术的临床病理资料，包括患者性别、年龄、原发肿瘤和复发肿瘤的病理学特征、再次肝切除术前全身状况、复发的出现时间及生存期等，根据随访结果计算总生存率和无瘤生存率，并作单因素及多因素分析。结果:48例患者再次切除术后中位生存时间36.3 个月，1、3、5 年累积生存率分别为81.3% 、45.8% 、27.1% ，1、3、5 年无瘤生存率分别为70.8% 、25.0% 、16.7% 。单因素分析结果显示:原发肿瘤TNM分期、原发肿瘤伴血管侵犯、复发间隔时间、复发肿瘤大小、复发肿瘤TNM分期、复发肿瘤伴血管侵犯影响再切除术后累积生存率；复发间隔时间、原发肿瘤TNM分期、复发肿瘤大小、复发肿瘤有无血管侵犯、复发肿瘤病理分级和AFP 水平影响再切除术后无瘤生存率。多因素分析显示:复发间隔时间、复发肿瘤TNM分期是影响复发性肝癌再切除术后累积生存的独立危险因素；复发间隔时间、复发肿瘤大小是影响其无瘤生存的独立危险因素。结论:肝内复发间隔时间短（≤24个月）、复发肿瘤直径>5cm、复发肿瘤TNM分期越晚，提示再次切除术后预后不良。 

Therapeutic Effect of Repeated Hepatectomy on 48 Cases of Recurrent Hepatocellular Carcinoma and Prognostic Factors

Objective: To analyze the therapeutic effect of repeated hepatectomy on recurrent hepatocellu-lar carcinoma and prognostic factors. Methods: We retrospectively analyzed the clinicopathologic data of 48 patients who underwent repeated hepatectomy for recurrent hepatocellular carcinoma between July 1995 and July 2003. Overall survival rate and disease-free survival (DFS) rate were calculated by Kaplan-Meier meth-od. Prognostic factors were analyzed by univariate and multivariate analysis. Results: The median survival of 48 patients was 36.4 months. The overall 1-, 3-, and 5-year survival rates were 81.3%, 45.8%, and 27.1%, re-spectively. The disease-free 1-, 3-, and 5-year survival rates were 70.8%, 25.0%, and 16.7%, respectively. Univariate analysis showed that TNM stage of primary tumor, TNM stage of the recurrent tumor, vascular in-vasion, recurrent tumor size (>5cm) and recurrence-free interval were prognostic risk factors for overall surviv-al. While TNM stage of primary tumor, recurrent tumor size (>5cm), TNM stage of recurrent tumor, vascular in-vasion, pathological grading of recurrent tumor, preoperative AFP and recurrence-free interval were prognos-tic risk factors for DFS. Multivariate analysis showed that recurrence-free interval and TNM stage of recurrent tumor were independent prognostic risk factors for overall survival. While recurrence-frae interval and recur-rent tumor size (>5cm) were independent prognostic risk factors for DFS. Conclusion: Short recurrence-free in-terval (≤24 months), recurrent tumor size (>5cm) and TNM stage of recurrent tumor indicate poor prognosis of patients who received repeated hepatectomy for recurrent hepatocellular carcinoma.