原发性肝癌手术预后的相关影响因素  

Factors influencing prognosis of primary liver cancer after hepatectomy

作　　者：汪晋[1] 马金良[1] 许戈良[1] 荚卫东[1] 余继海[1] 葛永胜[1] 曹堃[1] 

机构地区：[1]安徽医科大学附属安徽省立医院肝脏外科 肝胆胰外科安徽省重点实验室,安徽省合肥市230001

出　　处：《世界华人消化杂志》2014年第35期5526-5532,共7页World Chinese Journal of Digestology

基　　金：安徽省自然科学基金项目;No.1208085MH133~~

摘　　要：目的:探究原发性肝癌术后患者预后情况,阐述影响原发性肝癌术后患者预后相关因素.方法:回顾性分析安徽医科大学附属安徽省立医院2007-01/2009-08收治的286例原发性肝癌患者临床材料及随访资料,采用KaplanM e i e r法计算患者的生存率,单因素分析行Log-rank检验,多危险因素采用C o x模型进行分析.结果:整体1、3、5年生存率为90.1%、70.1%、26.3%,中位生存时间为37 m o.单因素分析结果显示:年龄、术前血清乙型肝炎病毒DNA(hepatitis B virus DNA,HBV DNA)水平、甲胎蛋白(alpha fetoprotein,AFP)、术前Child分级、术前丙氨酸氨基转移酶(alanine aminotransferase,ALT)高低、肝硬化、肿瘤大小、数目、包膜是否完整、腹腔淋巴结转移、病理脉管癌栓、围手术期输血、术后辅助治疗与肝癌患者预后明显相关(P<0.05);多因素分析结果显示:年龄、术前Child分级、术前ALT值高低、肝硬化、术前血清H B V D N A水平、A F P、肿瘤数目、包膜是否完整、腹腔淋巴结转移、病理脉管癌栓、围手术期输血及术后辅助治疗是影响肝癌患者预后的独立危险因素(P<0.05).结论:肝癌术后患者预后受多因素影响,术前早发现早诊断早治疗、术中精细操作以及术后积极复查并积极行相关辅助治疗是改善肝癌患者预后的重要途径.AIM： To explore the prognosis of primary liver cancer （PLC）, and to analyze the prognostic factors in patients with PLC after hepatectomy. METHODS： Clinical data for patients with PLC （n = 252） who underwent hepatectomy at Anhui Provincial Hospital from January 2007 to August 2008 were analyzed retrospectively. Survival rates were calculated by the Kaplan-Meier method. Factors related to the prognosis of PLC were screened by the Log-rank test and Cox regression. RESULTS： The 1-, 3-, and 5-year cumulative survival rates were 90.1%, 70.1% and 26.3%, respectively. Univariate analysis showed that age, hepatitis B virus DNA （HBV DNA） level, alpha fetoprotein （AFP）, preoperative Child-Pugh score, alanine aminotransferase （ALT） value, liver cirrhosis, tumor size, number of nodules, presence or absence of intact fibrous capsule, lymph node metastasis, vascular invasion, perioperative vascular invasion, and adjuvant therapy after hepatectomy were associated with prognosis （P 〈 0.05）. Multivariable analysis showed that age, HBV DNA level, AFP, preoperative Child-Pugh score, ALT value, liver cirrhosis, tumor size, number of nodules, presence or absence of intact fibrous capsule, lymph node metastasis, vascular invasion and perioperative vascular invasion were independent prognostic factors （P 〈 0.05）. CONCLUSION： The prognosis of patients with PLC after hepatectomy is influenced by many factors. Early discovery, diagnosis and treatment, careful intraoperative manipulation, and postoperative examination and relevant auxiliary treatment can help improve the prognosis of patients with PLC after hepatectomy.

关 键 词：肝肿瘤 预后 生存率 

分 类 号：R735.7[医药卫生—肿瘤]