血清HBeAg状态对肝细胞癌患者术后生存的影响  

Effect of Preoperative Serum HBeAg Status on Recurrence and Survival in Hepatocellular Carcinoma Patients after Radical Resection

作　　者：孙惠川[1] 张伟 钦伦秀[1] 叶青海[1] 王鲁[1] 任宁[1] 庄鹏远[1] 朱小东[1] 陆录[1] 钱永兵[1] 郭家恺[1] 项世骏[1] 张玮德[1] 樊嘉[1] 汤钊猷[1] 

机构地区：[1]复旦大学肝癌研究所,复旦大学附属中山医院肝脏外科,上海200032

出　　处：《中国普外基础与临床杂志》2007年第1期32-38,共7页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的研究肝癌患者血清HBeAg状态对肝癌切除术后复发及生存的影响。方法收集1999～2005年在我科行根治性切除的223例肿瘤直径≤3cm的肝癌患者的资料。根据患者术前血清HBeAg状态，分为HBeAg阳性组（n=73）和HBeAg阴性组（n=150），比较2组患者无瘤生存率（DFs）和总体生存率（OS），并分析影响DFS和OS的危险因素。结果HBeAg阳性和HBeAg阴性患者的1、3、5年的OS分别为91．5％、76．8％、60．1％和95．2％、85．3％、73．2％（P=0．053）；1、3、5年DFS分别为73．3％、53．7％、40．3％和86．6％、65．5％、54．5％（P=0．002）。与HBeAg阴性组比较，HBeAg阳性组患者年龄较轻（P=0．004），肝硬变较重（P=0．008），而在肿瘤因素及手术相关因素方面2组间的差异无统计学意义（P〉0．05）。对DFS和OS的多因素分析显示，年龄〉50岁、HBeAg阳性和大结节肝硬变是影响OS的独立危险因素，而HBeAg阳性和多发肿瘤是影响DFS的独立危险因素。结论小肝癌患者术后HBeAg阳性患者较HBeAg阴性者更易早期复发，而且总体生存较差。Objective To study the effect of HBeAg on recurrence and survival after radical resection of small （≤3 cm） hepatocellular carcinoma （HCC）. Methods Two hundreds and twenty-three HCC patients undergone radical resection from 1999 to 2000 were divided into two groups according to serum HBeAg status, HBeAg positive group （n= 73） and HBeAg negative group （n= 150）. The patients＇ factors, operative factors and tumorous facors were studied retrospectively between the two groups. And risk factors of overall survival （OS） and disease-free survival （DFS） were analyzed. Results There were no significant differences in operative and tumorous factors between the two groups, but the HBeAg positive group were younger with more severe cirrhosis （P= 0. 004, P = 0.008）. The OS and DFS were significantly different between the HBeAg positive group and HBeAg negative group. The 1-, 3- and 5-year OS were 91.5%, 76.8%, 60, 1% and 95.2%, 85. 3%, 73, 2%, respectively （P= 0.053）; and the 1-, 3- and 5-year DFS were 73. 3%, 53. 7%, 40.3% and 86.6%, 65.5%, 54.5%, respectively （P=0.002）. Multivariate analysis revealed that age 〉50 years, HBeAg positive and macronodular cirrhosis were significantly related to OS, and HBeAg positive, multiple tumor nodulars were significantly related to DFS. Positive serum HBeAg status was an independent risk factor for both OS and DFS. Conclusion Positive serum HBeAg is closely related to early recurrence and survival after radical resection of patients with small HCC.

关 键 词：肝细胞肝癌 根治性切除 乙型肝炎E抗原 总体生存 无瘤生存 

分 类 号：R735.7[医药卫生—肿瘤]