经皮微波固化治疗小肝癌复发及生存时间的影响因素分析  

Risk factors of recurrence and survival time for single small liver cancer after percutaneous microw ave coagulation therapy

作　　者：杨洋[1,2] 杜文军[2] 史兆章[2] 郑昭敏[2] 陈士俊[2] 

机构地区：[1]山东大学医学院,济南250012 [2]济南市传染病医院介入治疗中心,济南250021

出　　处：《山东大学学报（医学版）》2014年第1期89-94,99,共7页Journal of Shandong University:Health Sciences

摘　　要：目的探讨乙肝肝硬化相关的单发小肝癌患者经皮微波固化治疗（PMCT）后影响复发及生存时间的高危因素。方法回顾分析130例患者3年的病例资料。1年内复发为早期复发组，2—3年复发为晚期复发组，无复发情况的作为无复发组。采用X^2检验，Logistic回归筛选复发高危因素；Cox比例风险模式筛选影响生存时间的高危因素。结果①130例患者3年内有81例复发（65．85％），早期复发组50例（39．06％），晚期复发组31例（25．20％）。②肿瘤边界不规整、肿瘤距大血管≤1cm与早期复发相关；血清HBV—DNA≥10^5 copies／mL与晚期复发相关。肿瘤边界不规整、肿瘤距大血管≤1cm、复发时间≤12个月与生存时间相关。结论PMCT后，肿瘤边界规整性差、肿瘤距大血管近是乙肝肝硬化相关的单发小肝癌患者早期复发的危险因素，血清HBV—DNA含量高是晚期复发的危险因素；肿瘤边界规整性、肿瘤距大血管距离及复发时间可显著影响患者的术后生存时间。Objective To investigate the risk factors of intrahepatic recurrence and survival time after percutaneous microwave coagulation therapy （PMCT） for single small liver cancer patients with hepatitis B virus related cirrhosis. Methods 130 patients＇ medical records for 3 years were analyzed retrospectively. The patients with intrahepatic recurrences were divided into the early （ ≤1 year） and late （2-3 years） recurrence groups, and the patients without recur- rence were defined as no recurrence group. The X2 test and Logistic analysis were used to evaluate the univariate and multivariate analyses associated with intrahepatic recurrence, respectively. Cox proportional hazard model was used to evaluate the univariate and multivariate analyses associated with the survival time. Results （~） 81 patients out of 130 cases were diagnosed with postoperative intrahepatic recurrence （65. 85% ）, in which 50 were early recurrence （39.06%） and 31 were late recurrence （25.20 % ）. ② The irregular boundary of tumor （ P = 0.010 ） and distance to the large vascular≤ 1 cm （P 〈 0.001 ） were related to the early recurrence, and the serum HBV-DNA titer （ 1〉 105 cop- ies/mL） was related to the late recurrence （P 〈0.001 ）. The irregular boundary of tumor （P 〈0.001 ）, distance to the large vascular ≤1 cm （P =0.007） and recurrence time ≤12 months （P =0. 008） were related to the survival time. Conclusion For the single small liver cancer patients with hepatitis B virus related cirrhosis, the irregular boundary of tumor and small diatance to the large vascular are independent risk factors of early recurrence; serum HBV-DNA titer is the risk factor of late recurrence; the irregular boundary of tumor, diatance to the large vascular and recurrence time are the independent risk factors of the survival time.

关 键 词：乙型肝炎 肝硬化 小肝癌 微波固化 复发 多因素分析 生存分析 

分 类 号：R512.6[医药卫生—内科学]