晚期小肝癌的临床预测因素及肝切除术预后研究  

Predictors and prognosis of patients with advanced stage small hepatocellular carcinoma after hepatectomy

作　　者：吕文平[1] 周开伦[2] 李杰[1] 向昕[1] 苏明[1] 董家鸿[1] 陈永亮[1] 

机构地区：[1]解放军总医院海南分院肝胆外科,海南三亚572013 [2]海南省人民医院肝胆外科,海口570311

出　　处：《解放军医学杂志》2013年第1期44-47,共4页Medical Journal of Chinese People's Liberation Army

基　　金：国家自然科学基金(30772493)~~

摘　　要：目的探讨晚期小肝癌（SHCC）的临床预测因素及其对肝切除预后的影响。方法回顾性分析解放军总医院肝胆外科1995年1月-2009年12月实施肝切除的110例SHCC患者的临床资料。采用Kaplan-Meier乘积极限法估计绘制生存曲线并计算生存率,采用Log-rank检验比较生存时间差异;采用logistic单因素和多因素回归分析晚期SHCC与9个常见临床因素之间的相互关系。结果 110例SHCC患者中,晚期SHCC 31例,占28.2%,中位存活时间为48.8个月（95%CI 29.2～68.4个月）,1、3、5年存活率分别为78.6%、61.6%、38.5%,早期SHCC 79例,占71.8%,中位存活时间为98.0个月（95%CI 73.8～122.2个月）,1、3、5年存活率分别为98.7%、83.8%、74.8%,早期SHCC患者生存率明显高于晚期SHCC患者（χ2=13.29,P=0.0003）。Logistic多因素回归分析发现AFP阳性是晚期SHCC的唯一独立预测因素（RR=14.45,95%CI 4.05-51.64,P〈0.001）。结论晚期SHCC患者预后不良,AFP阳性是晚期SHCC预测因素。Objective To investigate the clinical predictors and prognosis of the patients with advanced stage small hepatocellular carcinoma（SHCC） after hepatectomy.Methods A total of 110 patients with SHCC admitted to the General Hospital of PLA and undergone hepatectomy from Jan.1995 to Dec.2009 were included in present retrospective study.Survival analysis was performed by Log-rank test and Kaplan-Meier.The association of SHCC and nine routine clinical parameters was analyzed by the univariate and multivariate logistic regression analysis.Results Of the 110 patients with SHCC,31（28.2%） were SHCC in advanced stage,and the 1,3,5 year survival rates were 78.6%,61.6% and 38.5%,respectively,with a median survival time of 48.8 months（95% CI 29.2-68.4 months）.Seventy-nine of the 110 patients（71.8%） were suffering form early stage SHCC,and the 1,3,5 year survival rates were 98.7%,83.8% and 74.8%,respectively,with a median survival time of 98.0 months（95%CI 73.8-122.2 months）.The survival rate was obviously higher in the patients with early stage SHCC than in those with advanced stage SHCC（χ2=13.29,P=0.0003）.Multivariate analysis showed that positive AFP was a potential significant predictor of SHCC in advanced stage（RR=14.45;95%CI 4.05-51.64,P0.001）.Conclusion The SHCC in advanced stage signifies an ominous prognosis.Positive AFP is a potential significant predictor for advanced stage SHCC.

关 键 词：癌 肝细胞 肿瘤分期 预后 甲胎蛋白类 

分 类 号：R735.7[医药卫生—肿瘤]