摘要目的 比较接受肝切除术治疗的巴塞罗那“中期”肝细胞癌各亚组患者的总生存率,并研究疗效随时间的变化情况.方法 连续性选取初次治疗方式为肝切除术的巴塞罗那中期肝细胞癌患者918例,分为3组:甲组:单个肿瘤且肿瘤直径≥5 cm,582例;乙组:2～3个肿瘤且最大直径＞3 cm,223例;丙组:3个以上肿瘤,n=113.比较3组患者在2001-2007年和2008-2013年的住院死亡率和总生存率.结果 丙组患者的住院死亡率显著高于另外两组(P＜0.05),但丙组患者的1、3、5年总生存率显著低于乙组患者(P＜0.05),而乙组患者又显著低于甲组患者(P＜0.05).甲、乙和丙3组患者的中位生存时间分别为47.3、36.9、和23.5个月.甲组和丙组患者在2008-2013年的总生存率显著优于2001-2007年(P＜0.05),但乙组患者在2008-2013年的总生存率仅稍优于2001-2007年(P=0.084).结论 3组患者的预后明显不同,肿瘤数量＞3的肝细胞癌患者行肝切除术后的住院死亡率最高而总生存率最低;随着手术技巧和围手术期护理技术的不断提高,肝切除术后肝细胞癌患者总生存率在不断提高.

abstractsObjective To compare the efficacy of hepatic resection (HR) in patients with Barcelona Clinical Liver Cancer (BCLC) Stage B hepatocellular carcinoma (HCC) and examine how that efficacy has changed over time in a large medical center.Methods A consecutive sample of 918 patients with preserved liver function and large and/or multinodular HCC who were treated by initial HR were divided into three groups:those with a single tumor ≥5 cm in diameter (n =582),2-3 tumors with a maximum diameter ＞ 3 cm (n =223),or ＞ 3 tumors of any diameter (n =113).Hospital mortality and overall survival (OS) in each group were compared for the years 2001-2007 and 2008-2013.Results Patients with ＞ 3 tumors showed the highest incidence of hospital mortality of all groups (P ＜ 0.05).Kaplan-Meier survival analysis showed that OS varied across the three groups as follows:single tumor ＞ 2-3 tumors ＞ 3 + tumors (all P ＜ 0.05).OS rate at 5 years ranged from 24％ to 41％ in all three groups for the period 2001-2007,and from 35％ to 46％ for the period 2008-2013.OS was significantly higher during the more recent 6-year period in the entire patient population,those with single tumor,and those with 3 + tumors (all P ＜ 0.05).However,in patients with 2-3 tumors,OS was only slightly higher during the more recent 6-year period (P =0.084).Conclusions Prognosis of three types of HCC was different.Patients with ＞ 3 tumors show the highest hospital mortality and lowest OS after HR.OS has been improving for all three types of HCC at our medical center as a consequence of improvements in surgical technique and perioperative management.