肝癌发生肺转移的危险因素分析  

Correlated factors of pulmonary metastasis of hepatoceilular carcinoma

作　　者：曾永毅[1] 张翔[1] 刘景丰[1] 仲杨[1] 王先明[1] 

机构地区：[1]福建医科大学附属第一医院肝病中心,福州350005

出　　处：《中华消化外科杂志》2013年第9期668-671,共4页Chinese Journal of Digestive Surgery

基　　金：福建省属高校基金（JK2011021）;福建省自然科学基金（201lJ01162）

摘　　要：目的探讨肝癌发生肺转移的危险因素，为防治肝癌肺转移提供理论依据。方法回顾性分析2008年1月至2012年3月福建医科大学附属第一医院收治的862例肝癌患者的临床资料。其中肺转移107例，将其血清AFP、GGT水平、是否合并HBV感染、肝内肿瘤情况、肝内肿瘤治疗情况等因素进行分析，寻找影响肝癌发生肺转移的危险因素。单因素分析采用COX比例风险模型，将有统计学意义的指标引入COX模型采用逐步后退法进一步进行多因素分析。结果单因素分析结果显示：AFP3400μg／L、GGT≥150U／L、合并HBV感染、肝内肿瘤数目32个、肿瘤未经手术切除或RFA、合并血管癌栓、伴有淋巴结转移是影响肝癌发生肺转移的危险因素，差异有统计学意义（RR=1．986，3．653，0．365，3．675，0．252，0．379，0．352，P〈0．05）。多因素COX逐步后退法分析结果显示：AFP3400μ/L、合并HBV感染、肝内肿瘤数目32个、肿瘤未经手术切除或RFA、合并血管癌栓、伴有淋巴结转移的肝癌患者更容易发生肺转移，差异有统计学意义（Pug=2．391，3．462，3．425，3．396，2．418，0．638，P〈0．05）。结论AFP3400μg／L、合并HBV感染、肝内肿瘤数目32个、肿瘤未经手术切除或RFA、合并血管癌栓、伴有淋巴结转移者是肝癌发生肺转移的危险因素，抗病毒治疗、早期积极手术治疗肝内瘤灶可能对防治肝癌发生肺转移有重要意义。Objective To investigate the correlated factors of pulmonary metastasis of hepatocellular carcinoma （HCC） , so as to provide theoretical evidences for the prevention and treatment. Methods The clinical data of 862 patients with HCC who were admitted to the First Affiliated Hospital of Fujian Medical University from January 2008 to March 2012 were retrospectively analyzed. There were 107 patients with pulmonary metastasis. Factors including serum alpha fetoprotein （AFP） level, serum gamma-glutamyl transpeptidase （GGT） level, hepatitis B virus （HBV） infection, presence and treatment of intrahepatic tumor were analyzed to screen out relevant factors of pulmonary infection of HCC. Univariate and multivariate COX regression model analysis were performed for data analysis. Results The results of univariate analysis showed that high level of AFP （ 〉400 ug/L）, ultra-high level of GGT （〉 150 U/L） , presence of HBV infection, the number of intrahepatic tumors t〉 2, no radical resection （or radiofrequency ablation ） for intrahepatic tumors, combining with tumor thrombi in the vessels, lymph node metastasis were risk factors of pulmonary metastasis of HCC （RR = 1. 986, 3. 653, 0. 365, 3. 675, 0. 252, 0. 379, 0. 352, P 〈 0.05）. The results of multivariate analysis showed that high level of AFP （ 〉400 ug/L） , HBV infection, the number of intrahepatic tumors 〉2, no radical resection （or radiofrequency ablation） for intrahepatic tumors, combining with tumor thrombi in the vessels were risk factors of puhnonary metastasis of HCC （RR =2. 391, 3. 462, 3. 425, 3. 396, 2. 418, 0. 638, P 〈 0.05）. Conclusions AFP t〉 400 p,g/L, HBV infection, the number of intrahepatic tumors i〉 2, no radical resection （ or radiofrequency ablation）, tumor thrombi in the vessels and lymph node metastasis are risk factors of pulmonary metastasis of HCC. Anti-hepatitis virus treatment and early treatment are helpful for the prevention and treatment.

关 键 词：肝肿瘤 肺转移 危险因素 

分 类 号：R735.7[医药卫生—肿瘤]