肝细胞癌患者微血管侵犯影响因素分析  

Influencing factors analysis of microvascular invasion in patients with hepatocellular carcinoma

作　　者：杜培源 宋京海[1] 乔江春[1] 贺修文[1] 张劲松[2] 陈剑[1] 吕骅[1] 朱明炜[1] 韦军民[1] Du Peiyuan;Song Jinghai;Qiao Jiangchu;He Xiuwen;Zhang Jinsong;Chen Jian;Lyu Hua;Zhu Mingwei;Wei Junmin(Department of Hepatobiliary and Pancreatic Surgery,Beijing Hospital,National Center of Geriatrics,Beijing 100730,China;Department of Pathology,Beijing Hospital,Beijing 100730,China)

机构地区：[1]北京医院肝胆胰外科国家老年医学中心,100730 [2]北京医院病理科,100730

出　　处：《中华肝胆外科杂志》2019年第1期26-29,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金(81671581).

摘　　要：目的评估微血管侵犯(MVI)与肝细胞癌(HCC)患者预后的相关性,并分析HCC患者MVI的影响因素。方法回顾分析2014年1月至2016年12月北京医院肝胆胰外科81例HCC患者资料,男65例,女16例,年龄(59.6±12.7)21~87岁。35例术后病理检查证实存在MVI,46例无MVI。所有患者均随访生存状况。单因素及多因素logistic回归分析HCC患者MVI影响因素。结果81例HCC患者76例获得术后随访。35例MVI患者术后1、2、3、4年总生存率分别为78.6%、55.4%、38.3%、32.2%。41例无MVI患者术后1、2、3、4年总生存率分别为93.4%、76.5%、68.2%、68.2%。两者比较差异有统计学意义(P<0.05)。多因素Cox回归分析显示,MVI是HCC患者术后生存的独立危险因素(HR=3.071,95%CI:1.239~7.610,P<0.05)。依据病理结果进行亚组(MVI灶数、MVI灶内细胞数、MVI灶距离肝癌原发灶距离、MVI分级)生存分析,各亚组分析差异均无统计学意义(P>0.05)。多因素logistic回归分析显示,肿瘤最大直径>5 cm(OR=6.340,95%CI:2.000~20.096)、术前总胆红素(TBil)>17 μmol/L(OR=5.067,95%CI:1.386~18.525)、术前甲胎蛋白(AFP)>400 μg/L(OR=6.042,95%CI:1.435~25.444)是HCC患者MVI的独立危险因素(P<0.05)。结论存在MVI的HCC患者预后不良。术前AFP、术前TBil和肿瘤直径大小是HCC患者MVI的影响因素。ObjectiveTo evaluate the correlation between microvascular invasion(MVI ) and prognosis in patients with hepatocellular carcinoma (HCC), and to analyse the influencing factors of MVI in patients with HCC.MethodsTotal of 81 patients with hepatocellular carcinoma treated in Beijing Hospital from January 2014 to December 2016 were retrospectively studied. There were 65 males and 16 females. The mean age was 59.6±12.7 years, and the age ranged from 21 to 87 years old. Pathological examination showed presence of MVI in 35 patients. ResultsTotal of seventy-six patients with hepatocellular carcinoma were followed-up. The 1-, 2-, 3- and 4-year overall survival rates in the 35 patients with microvascular invasion of hepatocellular carcinoma were 78.6%, 55.4%, 38.3%, and 32.2%, respectively. The 1-, 2-, 3-, and 4-year overall survival rates of the 41 patients without microvascular invasion were 93.4%, 76.5%, 68.2% and 68.2%, respectively. The difference was significant (P<0.05). Cox multivariate regression analysis showed that microvascular invasion was an independent risk factor of overall survival after surgery (HR=3.071, 95%CI: 1.239~7.610, P<0.05). Sub-group analysis was done on patients with microvascular invasion based on pathological results which included the number of MVI lesions, the cell number in the MVI lesion, the distance of the MVI to the primary liver cancer, and the gradings of MVI. There were no significant differences in the overall survival outcomes (P>0.05). Multivariate logistic regression analysis showed the maximum diameter of tumor >5 cm (OR=6.340, 95%CI: 2.000~20.096), preoperative total bilirubin (TBil)>17 μmol/L (OR=5.067, 95%CI: 1.386~18.525), and preoperative alpha-fetoprotein (AFP)>400 μg/L (OR=6.042, 95%CI: 1.435~25.444) were independent risk factors of microvascular invasion (P<0.05).ConclusionHepatocellular carcinoma patients with microvascular invasion had poor prognosis. Preoperative AFP, preoperative TBil, and diameter of tumor were independent risk factors of microvascular invasion

关 键 词：癌 肝细胞 预后 微血管侵犯 影响因素 

分 类 号：R735.7[医药卫生—肿瘤]