乙肝肝硬化相关早期肝癌切除术预后  

Prognosis after resection of early hepatocellular carcinoma in HBV-related cirrhotic patients

作　　者：朱倩[1] 乔国梁[2] 晏建军[2] 吴孟超[2] 严以群[2] 

机构地区：[1]湖北省荆门市第一人民医院肝胆外科,448000 [2]第二军医大学东方肝胆外科医院肝外一科,上海

出　　处：《中华肝胆外科杂志》2014年第4期258-264,共7页Chinese Journal of Hepatobiliary Surgery

基　　金：基金项目：国家重大科技基金（2008ZX10002-025）

摘　　要：目的研究乙肝肝硬化相关早期肝癌肝切除术复发危险因素及预后。方法通过临床监测、流行病学和终末结果数据库确诊早期肝癌，包括肿瘤直径≤5cm，没有肝内转移灶、远处转移或者主要血管侵犯。所有患者均施行肝切除术（不包括射频及肝移植术）。2005年4月至2010年11月东方肝胆外科医院共确诊肝癌患者20700例。本文回顾性分析其中537例早期肝癌患者的临床特点和预后因素。生存分析使用Kaplan-Meier函数及Cox模型。结果537例乙肝肝硬化早期肝癌患者的中位肿瘤直径为2．9cm，其中33％的患者肿瘤直径≤2em。绝大多数早期肝癌患者肿瘤单发（63％）且没有血管侵犯证据（64％）。术后总体中位生存时间及5年生存率分别为45个月及33％。综合分析年龄、性别及病理分期等因素显示，肿瘤直径〉2cm[风险比（HR）：1．56]、多病灶（HR：1．34）、血管侵犯（HR：2．03）为影响预后的独立危险因素（P〈0．05）。根据这些研究结果，建立一个早期肝癌预后评分系统，分成4个组（中位生存时间及5年生存率），0分（97个月，96％），1分（85个月，76％），2分（76个月，54％），3分（56个月，39％），各组间差异有统计学意义（P〈0．01）。结论病理分期对于早期肝癌手术预后的判断具有重要意义，解剖性肝切除是乙肝肝硬化相关早期肝细胞癌患者最佳手术选择。Objective To identifyclinicopathologic factors which predict survival following hepatectomy in HBV-related cirrhotic patients with early hepatocellular carcinoma （HCC）. Methods A database was used to identify patients with histologically confirmed early HCC （ ≤5 cm, no nodal involvement, metastases, or major vascular invasion） who underwent surgical resection （excluding ablation or transplantation）. Among 20 700 patients with HCC who were diagnosed at the Eastern Hepatobiliary Surgery Hospital from April 2005 to November 2010, 537 （2.6%） patients with early HCC were studied retrospectively. Prognostic factors were evaluated using the Kaplan-Meier curves, Cox proportional hazards models and the receiver operating characteristic （ROC） curves. Results The study included 537 patients. The median tumor size was 2.9 em, and 33% of patients had tumors ≤2 cm. Most HCC lesions were solitary （63%） and had no evidence of vascular invasion （64%）. Following surgery, the overall median and 5-year survival were 45 months and 33% respectively. After adjusting for demographic factors and histological grade, tumor size 〉 2 cm （ hazard ratio [ HR ] ： 1.56）, multifocal tumors （ HR ： 1.34）, and vascular invasion （ HR ： 2.03 ） remained independent predictors of poor survival （ all P 〈 0.05 ）. Based on these findings, a prognostic sco- ring system was developed that allotted 1 point each for these factors. Patients with early HCC could be strat- ified into 4 distinct prognostic groups （ median and 5-year survival, respectively） ： 0 points （ 97 months, 96%）, 1 point （85 months, 76%）, 2 points （76 months, 54%）, 3 points （56 months, 39%） （P 〈 0.01 ）. Conclusions The present study emphasized the importance of pathologic staging even in patients with small HCC. Anatomical resection of HCC should be the preferred surgical procedure in cirrhotic patients.

关 键 词：肝细胞癌 肝硬化 预后 肝切除 危险因素 

分 类 号：R735.7[医药卫生—肿瘤]