丙肝相关性肝癌根治术后复发规律及危险因素分析  

Analysis of recurrence profiles of hepatitis C virus-related hepatocellular carcinoma after radical resection and the risk factors

作　　者：丁同领[1] 赵新[2] 肖朝辉[2] 余灵祥[2] 乐羿[2] 洪智贤[2] 张绍庚[1,2] 

机构地区：[1]福建医科大学福州总医院临床医学院肝胆外科,福建福州350025 [2]中国人民解放军第三O二医院肝胆外科,北京100039

出　　处：《中国普通外科杂志》2014年第1期22-27,共6页China Journal of General Surgery

摘　　要：目的:分析丙肝相关性肝癌(HCV-HCC)根治术后复发规律及相关危险因素,探讨针对复发时相的个体化临床干预。方法:回顾98例行HCV-HCC根治术的患者临床病理资料,分析患者根治术后复发规律,对复发的可能影响因素进行单因素及多因素分析,并对病毒因素进行分层分析。结果:全组根治术后有2个复发高峰,以24个月为界分为早、晚期;COX比例风险模型分析显示,肿瘤低分化、镜下微血管侵犯为术后早期复发的独立危险因素(P<0.001),病毒载量为晚期复发的独立危险因素(P=0.013);术后病毒载量持续阴性患者无瘤生存期明显长于术后持续高病毒载量或病毒载量不稳定者(P<0.001)。结论:HCV-HCC根治术后早、晚期复发影响因素不同;早期复发率较高,预防性TACE可改善早期复发高危者预后;术后抗病毒治疗可改善远期疗效。Objective： To analyze the recurrence profiles of the hepatitis C virus-related hepatocellular carcinoma （HCV- HCC） after radical resection and the risk factors, and discuss the individualized clinical interventions for different recurrent phases. Methods： The clinicopathologic data of 98 HCV-HCC patients undergoing radical resection were reviewed. The recurrence profiles of these patients after radical resection were analyzed, and the risk factors for recurrence were determined by both univariate and multivariate analysis. Moreover, the viral factor was evaluated using stratified analysis. Results： Two peaks of recurrence after radical resection were observed in the entire group of patients, and demarcation point between the early and late recurrence was at postoperative 24 months. COX proportionalhazards regression model indicated that the low differentiation of tumor cells and microscopic vascular invasion were independent risk factors for early recurrence （P〈0.001）, whereas, the viral load was the independent risk factor for late recurrence （P=0.013）. Further stratified analysis indicated that the patients with sustained negative viral load after surgery had a significantly longer tumor-free survival time than those with sustained high viral load or unstable viral load after surgery （P〈0.001）. Conclusion： Different risk factors are responsible for the early and late recurrence after HCV-HCC redical resection. Early recurrence is relatively high, and the postoperative prophylactic TACE may improve the tumor free survival in early recurrence high-risk patients, while postoperative antiviral therapy may improve long-term outcomes of the patients.

关 键 词：丙型肝炎病毒 肝细胞癌 复发 危险因素 

分 类 号：R735.7[医药卫生—肿瘤]