肝切除治疗巨大肝细胞癌的预后影响因素  

Prognostic factors of survival in patients with huge hepatocellular carcinoma after hepatectomy

作　　者：高胜[1] 张志明[1] 刘剑勇[1] 赵荫农[1] 吴飞翔[1] 马良[1] 

机构地区：[1]广西医科大学附属肿瘤医院肝胆外科,南宁530021

出　　处：《中华肝胆外科杂志》2014年第9期625-629,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：广西医疗卫生重点科研课题（重200611）;广西科学基金项目（桂科自0728196）;广西科学研究与技术开发计划项目（桂科攻0719006-2-5）;广西科学研究与技术开发计划攻关项目（桂科攻1355005-3-3）

摘　　要：目的 分析巨大肝细胞癌手术切除治疗的预后影响因素,寻找提高疗效的途径.方法 回顾性分析我院2004年1月至2010年12月经手术切除及术后病理证实的124例巨大肝细胞癌患者临床资料.采用SPSS 19.0软件包进行单因素和多因素分析,对可能与患者预后有关的因素进行统计学分析.结果 全部124例患者,总体1、3、5年生存率分别为65.1％、35.8％、25.1％,平均生存时间为34.7个月,中位生存时间为26.0个月.65例根治性切除患者的1、3、5年无瘤生存率分别为40.2％、19.3％、7.1％,平均无瘤生存时间为18.6个月,中位无瘤生存时间为9.0个月.单因素分析显示HBsAg、肿瘤包膜、肝硬化、脉管癌栓、术前肿瘤破裂、肝内转移、根治性切除、巴塞罗那肝癌临床（BCLC）分期与患者的预后有关（均P＜0.05）.Cox模型多因素分析显示有无肝内转移、肝硬化以及是否行根治性切除和HBsAg是否阳性为患者预后的独立影响因素（均P＜0.05）.结论 肝内转移、肝硬化、HBsAg阳性是影响巨大肝细胞癌手术预后的独立危险因素.提高巨大肝癌根治切除率,能明显延长患者术后生存期.Objective To analyze the prognostic factors of survival in patients with huge hepatocel lular carcinoma （HCC） who underwent hepatectomy with a view to improve treatment efficacy.Methods A retrospective study was conducted on 124 patients with huge hepatocellular carcinoma who underwent hepatectomy for HCC from January 2004 to December 2010 in our hospital.Univariate and multivariate analyses were performed using statistical software （SPSS 19.0 for Windows） to identify independent prognostic factors.Results The cumulative 1-,3-and 5-year survival rates of the 124 patients were 65.1%,35.8% and 25.1% respectively.The mean survival and the median survival were 34.7 and 26.0 months respectively.In the 65 patients who underwent curative resection,the 1-,3-and 5-year disease-free survival rates were 40.2%,19.3% and 7.1% respectively.The mean disease-free survival and the median disease-free survival were 18.6 and 9.0 months respectively.Univariate analysis showed HBsAg,tumor capsule,liver cirrhosis,vascular invasion,tumor rupture,intrahepatic metastasis,curative resection and BCLC staging significantly affected postoperative survival（P 〈 0.05）.The Cox multivariate analysis indicated HBsAg,liver cirrhosis,curative resection and intrahepatic metastasis were independent prognostic factor （P 〈 0.05）.Conclusions Intrahepatic metastasis,liver cirrhosis and HBsAg were prognostic factors influencing survival outcome of huge HCC in patients after hepatectomy.Improving curative resection rate of huge HCC significantly extended survival for these patients.

关 键 词：肝切除术 巨大肝癌 预后因素 

分 类 号：R735.7[医药卫生—肿瘤]