原发性肝癌根治术后不同复发时期高危因素及疗效研究  

Investigation of risk factors and therapy effection for different recurrent stage after resection of hepatocellular carcinoma

作　　者：蔡欣然[1] 黄长玉[1] 周良艺[1] 周浩辉[1] 

机构地区：[1]福建医科大学附属协和医院肝胆外科,福建福州350001

出　　处：《实用肿瘤杂志》2010年第5期560-563,共4页Journal of Practical Oncology

基　　金：福建省自然科学基金计划资助项目;编号C0310020

摘　　要：目的探讨原发性肝癌根治切除术后近、远期复发的相关因素及治疗和预后。方法回顾性分析110例根治性切除并经病理证实的原发性肝细胞癌,总结其临床资料及病理学特征并行统计学分析。结果 (1)本组病例术后复发58例(复发率52.7%),其中近期复发(≤12月)27例,远期(>12月)31例。多因素COX回归分析门静脉分支癌栓为近期复发唯一危险相关因素(P=0.011);肝组织HBVDNA含量、肿瘤手术切缘为远期复发危险因素(P<0.05)。(2)近期复发多为肝内多发病灶(>2个)(62.9%),远期复发以单发灶为主(64.5%),两组差异有统计学意义(P<0.05)。(3)近、远期复发组术后3、5年生存率分别为37.1%、15.4%和76.5%、33.2%,两组差异有统计学意义(P<0.01)。(4)复发病例治疗包括再手术、介入治疗(TACE、PEI、微波),手术组生存率显著大于非手术组(P<0.05)。结论肝癌术后近、远期复发相关危险因素不同,根据高危因素选择适当的治疗对于延长复发时间及生存期有重要意义。远期复发多为单发病灶,争取再手术切除仍可取得较好的疗效。Objective To investigate the risk factors and therapy effection for different recurrent stage after resection of hepatocellular carcinoma（HCC）.Methods 110 cases receiving radical resection of HCC confirmed by pathology were analyzed retrospectivly to review the clinical characteristics,pathological features and treatment.Results（1）Recurrence was occurred in 58 cases of the group（52.7%）,of which 27 cases had recent recurrence（≤12 months）,31 had the late recurrence（12 months）.Multivariate COX regression analysis showed the portal vein tumor thrombus was the only risk factor for the recent recurrence,while liver tissue HBVDNA content and surgical margins were significant risk factors for late recurrence.（2）The most recent recurrence was multiple lesions（62.9%）,the late recurrence in majority cases was single lesion（64.5%）,there was significant difference between the two groups（P0.05）.（3）The overall 3-and 5-year survival rates were markedly lower after the recent recurrence（37.1%,15.4%） than those after the late recurrence（76.5%,33.2%）（P0.01）.（4）The treatment of recurrent cases included re-resection,interventional therapy（TACE,PEI,microwave,etc）.The survival rate of the reoperative group was significantly greater than that of the interventional group（P0.05）.Conclusions The risk factors for different recurrent stage are different.Selecting the proper treatment according to high risk factors may significantly prolong the time of recurrence and survival.Late recurrence in most cases is single lesion,and a better efficacy can be achieved by surgical resection for them.

关 键 词：癌 肝细胞 复发 危险因素 因素分析 统计学 回顾性研究 

分 类 号：R735.7[医药卫生—肿瘤]