27 The Journal of Bone and Joint Surgery (Br) 2009 91-B: 1505-1512. 肝細胞癌骨転移患者における外科的治療後の生存率 Survival of patients with skeletal metastases from hepatocellular carcinoma after surgical management By H.S. Cho, MD*, J.H. Oh, MD, I. Han, MD, and H.-S. Kim, MD Abstract: 要約： Skeletal metastases from hepatocellular carcinoma are highly destructive vascular lesions which severely reduce the quality of life. Pre-existing liver cirrhosis presents unique challenges during the surgical management of such lesions. We carried out a retrospective study of 42 patients who had been managed surgically for skeletal metastases from hepatocellular carcinoma affecting the appendicular skeleton between January 2000 and December 2006. There were 38 men and four women with a mean age of 60.2 years (46 to 77). Surgery for a pathological fracture was undertaken in 30 patients and because of a high risk of fracture in 12. An intralesional surgical margin was achieved in 36 and a wide margin in six. Factors influencing survival were determined by univariate and multivariate analyses. The survival rates at one, two and three years after surgery were 42.2%, 25.8% and 19.8%, respectively. The median survival time was ten months (95% confidence interval 6.29 to 13.71). The number of skeletal metastases and the Child-Pugh grade were identified as independent prognostic factors by Cox regression analysis. The method of management of the hepatocellular carcinoma, its status in the liver, the surgical margin for skeletal metastases, the presence of a pathological fracture and adjuvant radiotherapy were not found to be significantly related to the survival of the patient, which was affected by hepatic function, as represented by the Child-Pugh grade. 肝細胞癌の骨転移は，血管に富んだ破壊性の病変であり，患者の QOL を著しく低下させる．肝細胞癌の前駆疾患として肝硬変が存在するため，そのような病変の外科的治療には特有の困難がある．2000 年 1 月∼ 2006 年 12 月に肝細胞癌の四肢骨転移を外科的に治療した 42 例について後ろ向き研究を行った．患者の内訳は男性 38 例，女性 4 例であり，平均年齢は 60.2（46 ∼ 77）歳であった．病的骨折に対する手術が 30 例に，骨折リスク回避目的の手術が 12 例に行われた．36 例で腫瘍内切除が行われ，6 例で広範切除縁が確保された．単変量解析と多変量解析により生存に影響する因子を検討した．生存率は術後 1 年で 42.2%，2 年で 25.8%， 3 年で 19.8% であった．生存期間中央値は 10 ヵ月（95% 信頼区間 6.29 ∼ 13.71）であった．Cox 回帰分析により，骨転移数と Child-Pugh 分類が独立予後因子として同定された．肝細胞癌の治療法，肝臓での癌の状態，骨転移の切除縁，病的骨折の存在，および補助放射線療法は，患者の生存率とは有意な相関を示さなかったが，ChildPugh 分類で示される肝機能は患者の生存率に影響を及ぼした． * Department of Orthopaedic Surgery, Kyungpook National University College of Medicine, 200 Dongduk-Ro Jung-Gu, Daegu, Korea. 28 The Journal of Bone and Joint Surgery (Br) 2009 91-B: 1505-1512. Reproduced with permission and copyright of The British Editorial Society of Bone and Joint Surgery [J Bone Joint Surg Br. 2009; 91: 1507]