肝细胞肝癌术后预后因素分析  

Prognosis of hepatocellular carcinoma： a study of 832 cases

作　　者：阎涛[1] 赵建军[1] 毕新宇[1] 赵宏[1] 黄振[1] 李智宇[1] 周健国[1] 李原[1] 李聪[1] 蔡建强[1] 赵平[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院腹部外科,100021

出　　处：《中华肿瘤杂志》2013年第1期54-58,共5页Chinese Journal of Oncology

基　　金：国家“十一五”重大专项课题基金（2008ZX10002-025）

摘　　要：目的探讨肝细胞肝癌（HCC）外科治疗后的预后影响因素。方法回顾性分析832例外科治疗HCC患者的临床资料，采用Kaplan-Meier法进行生存分析，应用Cox比例风险模型进行多因素回归分析。结果832例患者术后1、3、5年生存率分别为92．0％、70．2％和53．6％，术后1、3、5年无复发生存率分别为90．2％、61．5％和40．5％。单因素分析显示，元临床症状、肿瘤≤5cm、肿瘤单发、分化程度好、无病理脉管瘤栓、血清甲胎蛋白（AFP）阴性、血清碱性磷酸酶（ALP）阴性、Child-Pu曲A级、无腹水、无或轻度肝硬化、解剖性分离法切除、无围手术期输血、无腹腔淋巴结转移、无大血管侵犯以及无肿瘤破裂或肝外侵犯的HCC患者生存情况较好。Cox多因素分析显示，有无临床症状、肿瘤大小、肿瘤数目、有无病理脉管瘤栓、血清AFP、肝硬化程度、肝脏外科切除技术、有无腹腔淋巴结转移、有无大血管侵犯、有无肿瘤破裂或肝外侵犯是HCC患者术后长期生存的独立影响因素，其中有无腹腔淋巴结转移、有无大血管侵犯和有无肿瘤破裂或肝外侵犯贡献较大，RR分别为4．607、4．103和3．955。结论HCC切除术后患者预后受多种因素影响，术前早诊早治、术中手术微创操作、术后预防肝硬化进展是改善患者术后生存的重要途径。Objective To investigate the prognostic factors of hepatocellular carcinoma. Methods The purpose of this study was to retrospectively analyze the surgical outcomes of hepatocellular carcinoma （HCC） in 832 patients who underwent hepatic resection between February 2002 and June 2010 in the Cancer Hospital of Chinese Academy of Medical Sciences. Post-resection prognostic factors were assessed using a univariate Kaplan-Meier analysis and a multivariate Cox proportional hazards model. Results The overall 1-, 3- and 5-year survival rates were 92.0% , 70.2% and 53.6% , respectively. The disease free survival rates （DFS） were 90.2% , 61.5% and 40.5% , respectively. The univariate analysis showed that a better prognosis for overall survival （OS） was associated with asymptomatic presentation, small tumor, single lesion, high-grade histological differentiation, no vascular tumor embolus, negative serum alpha- fetoprotein （AFP）, negative serum alkaline phosphatase （ALP） , Child-Pugh class A, no ascites, no/mild cirrhosis, new surgical techniques, no blood transfusion, no regional lymph node metastasis, no major vascular invasion, and no extra-hepatic invasion. The multivariate analysis showed that asymptomatic presentation, small tumor, single lesion, no tumor embolus, negative serum alpha-fetoprotein （AFP）, no regional lymph node metastasis, no major vascular invasion, no extra-hepatic invasion, no/mild cirrhosis, and surgical techniques are independent factors for a longer overall survival. Conclusions The prognosis of HCC after resection is influenced by a number of factors. Therefore, regularly screening and early diagnosis, applying surgical techniques to minimize the liver injury, and preventing the aggravation of cirrhosis are important measures to improve the overall survival of HCC patients. For those patients with high risk factors of recurrence, routine follow-up is one of the best methods to be recommended.

关 键 词：癌 肝细胞 预后 肝炎 病毒性 人 肝硬化 外科疗法 

分 类 号：R735.7[医药卫生—肿瘤]