高龄肝细胞癌患者肝切除术后手术效果与预后影响因素的分析  

Outcomes of Hepatectomy and Effect of Prognostic Factors in Elderly patients(70 Years or Older)with Hepatocellular Carcinoma

作　　者：李明非[1,2] 甘险峰[2] 杨训[2] 蒋佶鹏 曾勇[1] 

机构地区：[1]四川大学华西医院附一院肝胆外科,四川成都610041 [2]四川省人民医院肝胆外科,四川成都610072

出　　处：《四川医学》2015年第3期357-361,共5页Sichuan Medical Journal

摘　　要：目的对于高龄(≥70)肝细胞癌(HCC)患者是否适合行肝切除术及各因素对患者生存率的影响进行评估。方法比较57位70及70岁以上的肝细胞癌患者(高龄组)与318位70岁以下的肝细胞癌患者(非高龄组)在接受肝切除术后总生存率及无瘤生存率之间的差异。同时,在高龄组中,对于各个可能影响预后的因素,以Cox’s比例风险回归模型进行分析。结果 3年及5年的总生存率,在高龄组中为56.1%及40.4%,在非高龄组中为63.8%及46.5%。3年及5年的无瘤生存率,在高龄组中为35.1%及35.1%,在非高龄组中为31.4%及21.7%,差异无统计学意义(P>0.05)。在高龄组中,对于各个可能影响预后的因素,单因素分析显示肝硬化、Child分级、TNM分期对手术效果的影响有统计学意义(P>0.05),而多因素分析中则显示,Child分级是影响手术效果的独立危险因素(P=0.045)。结论对于适当的高龄(≥70岁)肝细胞癌患者,接受肝切除术治疗可以获得同较年轻患者相同的疗效。Objective To evaluate the outcomes of hepatectomy and the effect of prognostic factors in elderly patients（70 years older） with hepatocellular carcinoma（ HCC） . Methods We compared overall survival rates and disease-free survival rates between 57 patients with HCC who were 70 years or older（ elderly group） and 318 patients with HCC who were younger than 70 years（ younger group） . And, in elderly group, we analysed the prognostic factors by means of multivariate analysis with a Cox’s proportional-hazards model. Results In elderly group, overall survival rates at 3 years and 5 years were respectively 56. 1% and 40. 4%, and, in younger group were respectively 63. 8% and 46. 5%. Disease-free survival rates at these conditon were 35. 1%and 35. 1% in elderly group and 31,4% and 21. 7% in youger group. There was no significant difference between these two groups（P〉0. 05）. In elderly group, multivariate analysis showed a significant association between Child-Pugh class an outcomes of hepatectomy. Conclusion To carefully selected elderly patients with hepatocellular carcinoma, the hepatectomy is same safe and survival beneficial as to younger patients.

关 键 词：肝细胞癌 高龄 生存率 预后影响因素 

分 类 号：R735.7[医药卫生—肿瘤]