早期肝癌病人术后复发危险因素分析  

Recurrence risk factors of patients with early hepatocellular carcinoma following hepatectomy

作　　者：乔国梁[1] 刘学[1] 刘光华[1] 樊啸[1] 夏勇[1] 沈锋[1] 

机构地区：[1]第二军医大学东方肝胆外科医院肝外四科,上海200438

出　　处：《外科理论与实践》2012年第5期437-443,共7页Journal of Surgery Concepts & Practice

基　　金：国家传染病防治科技重大专项(2008ZX10002-025;2012ZX10002-016)

摘　　要：目的:分析影响早期肝癌术后复发的危险因素。方法:回顾性分析2002年1月至2004年12月手术切除并获得随访的197例经组织学确认为早期肝癌(单发,≤5 cm,无淋巴结及远处转移,无门静脉癌栓)病人,利用K-M生存曲线分析来评估不同组病人的复发差异,采用COX比例风险回归模型来研究与早期肝癌复发相关的危险因素。结果:197例病人中,肿瘤的中位直径为2.8 cm,肿瘤直径>2 cm的病人占58.4%,病人血清AFP阳性(>100 ng/mL)占47.7%,病理结果提示有微血管癌栓(MVI)者为32.5%。术后中位复发时间(TTR)为28.5个月,总体复发率为59.4%。术后1、3、5年的累积复发率分别为26.4%、55.6%、66.0%。我们建立了一个包含3组的早期肝癌复发评估系统,组中位TTR和1、3、5年复发率分别为:0分组(40.9个月和9.9%、26.7%、41.7%)、1分组(31.1个月和14.1%、50.1%、63.0%)、2～3分组(18.9个月和48%、71.8%、89.1%)(P<0.001)。结论:肿瘤大小、AFP水平和MVI是早期肝癌术后复发的独立危险因素。在不同危险因素存在的情况下,早期肝癌病人的复发时间差异明显。Objective To identify and analyze clinicopathologic risk factors associated with recurrence in patients with early hepatocellular carcinoma（HCC） after hepatectomy. Methods From Jan 2002 to Dec 2004, the clinicopathologic characteristics and follow-up data of 197 patients undergoing hepatectomy for early ttCC （solitary, ≤5 cm and no lymph nodal involvement, metastases, or major vascular invasion） were retrospectively studied. The diagnosis of the patients were all pathologically confirmed. The differences among groups that related to tumor recurrence were evaluated using Kaplan- Meier curves and COX proportional hazards models were applied to identify the risk factors of tumor recurrence.Results The median tumor size was 2.8 cm. 58.4% patients had tumors 〉2 cm and 47.7% patients had high AFP levels （〉100 ng/mL）. 32.5% of tumors with evidence of microscopical vascular invasion （MVI） was. Following hepatectomy, the median time to recurrence （TFR） and the overall rate of recurrence were 28.5 months and 59.4%, respectively. The 1, 3, 5 year rate of recurrence after hepatectomy were 26.4%, 55.6%, and 66.0%, respectively. Based on these findings, a recurrent scoring system（RSS） was developed that allotted 1 point for each of the aforementioned risk factors. Patients with early HCC could be stratified into 3 distinct recurrent groups according to different RSS scores. The median TrR and 1, 3, 5 year rate of recurrence were 40.9 months and 9.9%,26.7%,41.7% （RSS=0）, 31.1 months and 14.1%,50.1%,63.0% （RSS=1）, 18.9 months and 48% ,71.8%,89.1% （RSS=2-3）, respectively, P〈0.001. Conclusions Tumor size, AFP level and MVI are the independent risk factors of tumor recurrence of patients with early HCC. Patients＇recurrent time varies significantly in the presence of different risk factors.

关 键 词：早期肝癌 复发预测 危险因素 肝切除术 

分 类 号：R735.7[医药卫生—肿瘤]