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  

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

作　　者：陈小菁[1] 周凯[1] 李斌奎[2] 黄亮[3] 李锦清[2] 张亚奇[2] 元云飞[2] 

机构地区：[1]江西省人民医院干部外科 [2]华南肿瘤学国家重点实验室中山大学肿瘤防治中心肝胆科,广州市510060 [3]南昌大学第二附属医院血管外科

出　　处：《中国肿瘤临床》2010年第2期96-100,共5页Chinese Journal of Clinical Oncology

摘　　要：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。Objective： To analyze the therapeutic effect of repeated hepatectomy on recurrent hepatocellular 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 multivadate 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 invasion, recurrent tumor size （〉5cm） and recurrence-free interval were prognostic risk factors for overall survival. While TNM stage of primary tumor, recurrent tumor size （〉5cm）, TNM stage of recurrent tumor, vascular invasion, 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-free interval and recurrent tumor size （〉5cm） were independent prognostic risk factors for DFS. Conclusion： Short recurrence-free interval （≤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.

关 键 词：肝细胞癌 复发 再切除 预后 

分 类 号：R735.7[医药卫生—肿瘤] R692.507[医药卫生—临床医学]