肝癌肝切除术后条件生存率分析  

Conditional survival after hepatic resection for hepatocellular carcinoma

作　　者：傅宏[1] 陈志良[1] 方剑锋[1] 俞南松[1] 

机构地区：[1]绍兴市人民医院,浙江大学绍兴医院肝胆胰外科,浙江绍兴312000

出　　处：《中华全科医学》2016年第5期760-762,共3页Chinese Journal of General Practice

摘　　要：目的评估肝癌切除术后患者的条件生存率。方法556例肝癌切除术后患者获得随访。3年条件生存率通过公式CS=S（X＋3）／S（X）获得，代表患者在术后已经活过X年的条件下能够继续存活3年的概率。结果1、3和5年总生存率分别是69．4％、36．1％和25．2％。单因素分析发现下列病理参数与生存率关联密切：肝癌分期、肿瘤分化、微血管侵犯、术中红细胞输入以及肝纤维化；多因素回归分析（COX回归）发现肝纤维化（RR=1．789；95％CI：1．046～3．059；P=0．034）、术中红细胞输入（RR=2．093；95％CI：1．252～4．746；P=0．021）以及肝癌分化（RR：0．279；95％CI：0．0752～0．936；P=0．029）是肝癌肝脏切除术后预后的独立危险因素；使用条件生存率评价，鉴于已存活1、2、3、4、5年后患者的3年条件生存率分别为38．9％、51．7％、64．4％、76．7％和78．4％。从第3年开始，肿瘤相关因素对肝癌患者长期生存的影响减弱。结论本次研究表明，以肝癌切除术时间为基点的生存率评价是动态的；条件生存率评价显示随着时间的推移，在肝癌切除术后不同变量对总体生存率的影响不是同步的。Objective To estimate the conditional survival for patientsafler hepatic resection for hepatocellular carcinoma （HCC）. Methods Clinical data from 556 patients who underwent HCC resection were reviewed and the actuarial survival estimated. The 3-year conditional survival was calculated as CS = S （x ＋ 3 ）/S （x） and represents the probability of surviving an additional 3 years,given that the patient has already survived x years. Results The 1-,3-,and 5-year survival rates were 69.0% ,57.7% , and 25.3 % , respectively. Single factor analysis found that the following pathological parameters were closely related tosurvival rate：staging of liver cancer, tumor differentiation, mierovascular invasion, intraoperatie red blood cell input and smaller values of the liver fibrosis. Themuhivariate analysisfound that the independent risk factors of long-term survival were fibrosis（ RR = 1. 789 ;95% CI： 1. 046 - 3. 059 ; P = 0. 034 ） , packed red blood cells transfusion （RR = 2. 093 ; 95% CI： 1. 252 - 4. 746 ; P = 0. 021 ） and differentiation （ RR = 0. 279 ; 95% CI： O. 0752 - 0. 936 ; P = 0.029）. The 3-year CS rate of the entire study cohort assessed at 1,2,3,4 and 5 years from thetreatment was 38.9% , 51.7% ,64.4% ,76.7% and 78.4% respectively. The CS of subgroups stratified by fibrosis, packed red blood cells transfusion and differentiation didn＇ t differ significantly from the third year after resection onward, as more advanced patients had probably escaped early recurrence. Conclusion Conditional survival showed that the impact of different variables influencing survival is not linear over time after hepatic resection. Information derived from conditional survival can be used to better manage patients with HCCs.

关 键 词：肝癌 肝切除术 条件生存率 预后 

分 类 号：R735.7[医药卫生—肿瘤] R730.7[医药卫生—临床医学]