切缘和肿瘤数目对小肝癌患者预后的影响  

Effect of resection margin and tumor number on survival of patients with small liver cancer

作　　者：荣维淇[1] 余微波[1] 吴凡[1] 吴健雄[1] 王黎明[1] 田斐[1] 安松林[1] 冯莉[1] 刘发强[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院腹部外科,100021

出　　处：《中华肿瘤杂志》2015年第12期928-931,共4页Chinese Journal of Oncology

摘　　要：目的探讨切缘和肿瘤数目对可手术小肝癌患者预后的影响。方法回顾性分析中国医学科学院肿瘤医院腹部外科2003年12月至2013年7月收治的219例小肝癌患者的临床资料，应用Logrank法比较不同切缘（≥1cm和〈1cm）、不同肿瘤数目（单发及多发）患者预后的差异，采用Cox风险比例模型进行多因素分析，探讨不同因素对生存的影响。结果全组患者的1、3、5和10年生存率分别为95．9％、85．3％、67．8％和53．3％。单因素分析结果显示，切缘〈1cm组患者的中位生存时间为28个月，切缘≥1cm组患者的中位生存时间为36个月，差异无统计学意义（P=0．249）。单发肿瘤组患者的中位生存时间为36个月，多发肿瘤组患者的中位生存时间为26个月，差异无统计学意义（P=0．448）。多因素分析的结果显示，切缘以及肿瘤数目均不是影响患者预后的独立因素（均P〉0．05）。结论小肝癌1cm切缘可能已经安全，扩大切缘并非能提高患者的生存时间；合理把握手术适应证，强化综合治疗理念，能够降低多发肿瘤对肝癌患者生存的不利影响。Objective To explore the significance of resection margin and tumor number on survival of patients with small liver cancer after hepatectomy. Methods We collected 219 cases with small liver cancer undergoing hepatectomy in Cancer Hospital, Chinese Academy of Medical Sciences between December 2003 to July 2013. The survival rates were compared by log-rank test between two resection margin groups （ ≥ 1 cm vs. 〈1 cm）, different tumor number groups （single tumor vs. multiple tumors）. We also performed a multifactor analysis by Cox model. Results The 1-, 3-, 5- and 10- year overall survival rates were 95.9%, 85.3%, 67.8% and 53.3%, respectively, in all patients. The median survival time was 28 months in the group of 〈 1 cm resection margin and 36 months in the group of ≥ 1 cm resection margin （P= 0.249）. The median survival time was 36 months in the group of single tumor and 26 months in the group of multiple tumors （P= 0.448）. The muhifactor analysis also did not show significant effect of resection margin and tumor number on the patients＇ survival. Conclusions For small liver cancer, the resection margin of 1 cm might be advised. Increasing resection margin in further could probably not improve therapeutic effect. Standardized operation and combined treatment will decrease the negative influence of multiple tumors on overall survival.

关 键 词：癌 肝细胞 肝切除术 切缘 肿瘤数目 预后 

分 类 号：R735.7[医药卫生—肿瘤]