528例原发性肝细胞癌患者肝切除术后1年生存分析  

Analysis on factors influencing one-year-survival of hepatocellular carcinoma patients after hepatectomy

作　　者：吴力群[1] 王祖森[1] 胡维昱[1] 韩冰[1] 曹景玉[1] 郭卫东[1] 张斌[1] 邱法波[1] 张顺[1] 

机构地区：[1]青岛大学医学院附属医院肝胆外科,266003

出　　处：《中华普通外科杂志》2012年第2期92-95,共4页Chinese Journal of General Surgery

摘　　要：目的探讨原发性肝细胞癌患者（hepatocellularcarcinoma，HCC）肝切除术后1年生存状况及影响因素。方法回顾性分析1997年1月至2008年12月因HCC行肝切除的528例患者术后1年生存结果和影响因素。结果本组患者随访期间死亡302例，患者1年累积生存率为84％。1年内死亡原因主要为HCC复发转移（78．1％，75／96）及与原发的肝病相关合并症（19．8％，19／96）。大肝癌（P=0．047）、血管癌栓（P=0．018）、组织学中低分化（P=0．001）和病理切缘肿瘤残留（P=0．004）者是HCC患者1年内HCC复发转移死亡的独立危险因素；伴有门静脉高压症（P=0．001）是预示术后肝病相关死亡的独立因素。非R0切除的患者是1年内死亡（占59．3％）最重要的因素。结论影响HCC切除术后1年生存的主要因素是HCC复发转移与原发的肝病相关因素，非R0切除是导致原发性HCC患者术后早期复发死亡的最主要的因素，术前伴有门静脉高压症是影响HCC患者术后肝病相关死亡的独立危险因素。Objective To analyze the factors that influence the survival condition during the first year after hepatectomy in patients with hepatocellular carcinoma （HCC）. Methods Five hundred twenty-eight HCC cases undergoing hepatectomy were included from January 1997 to December 2008. The factors and survival outcomes in these patients were analyzed. Results There were 302 patients dying during a medium follow-up of 35 months and 1-year cumulative survival was 85%. The causes of death during first year were tumor recurrence （78.1%, 75/96） and liver dyscompensation （19. 8%, 19/96）. By Cox regression analysis, tumor size≥5 cm （ P = 0. 047 ）, vascular invasion （ P = 0. 018 ）, histologic moderately and poorly differentiation （ P = 0. 001 ） and pathologically positive margin （ P = 0. 004 ） were significantly associated with tumor recurrence, and portal hypertension was an independent factor for patients dying from liver dysfunction （ P = 0. 001 ）. Positive tumor margin was the most important factor associated with postoperative death within one year （59.3%, 60/96）. Conclusions During the first year after HCC resection, tumor recurrence and liver dysfunction are main factors influencing HCC patients＇ survival, non- R0 resection is the main factor causing tumor recurrence, and portal hypertension is an independent factor for patients dying of liver dyscompensation.

关 键 词：癌 肝细胞 肝切除术 肿瘤复发 局部 

分 类 号：R735.7[医药卫生—肿瘤]