Bolondi再分期模型对中期肝癌患者肝切除术后生存的预测作用  

Survival prediction of the Boiondi substaging model for patients with intermediate-stage hepatocellular carcinoma after hepatectomy

作　　者：尉文新[1] 雷正清 王葵[1] 夏勇[1] 李俊[1] 阎振林[1] 沈锋[1] 

机构地区：[1]第二军医大学东方肝胆外科医院肝外四科,上海200438

出　　处：《中华消化外科杂志》2016年第5期496-503,共8页Chinese Journal of Digestive Surgery

基　　金：国家科技重大专项课题（2012ZX10002-016）

摘　　要：目的探讨巴塞罗那中期肝细胞癌（肝癌）Bolondi再分期模型对肝切除术后患者总体生存的预测作用。方法采用回顾性队列研究方法。收集2008年2月至2010年1月第二军医大学东方肝胆外科医院收治的343例中期肝癌患者的临床病理资料。患者人院后均进行详细的病史采集和体格检查，完善相关实验室和影像学检查。根据评估结果行肝切除术。研究方法：（1）按Bolondi再分期模型将患者分为B1组、B2组和B3／4组，并分析各组患者的预后。（2）分析影响B1组和B2组患者预后的因素。（3）以微血管侵犯（MVI）情况，将B1组和B2组患者分为4组（M1组：B1组MVI阴性，M2组：B1组MVI阳性，M3组：B2组MVI阴性，M4组：B2组MVI阳性）进行分层分析。观察指标：（1）患者基本临床病理特征。（2）B1组、B2组和B3／4组患者生存情况。（3）影响B1组和B2组患者预后的危险因素分析。（4）B1组和B2组患者MVI分层分析。所有患者在术后采用电话或门诊进行随访。术后2年内每3个月检查1次腹部超声，肝功能和血清AFP。2年后每6个月复查1次。随访截止时间为2014年2月。连续变量资料以M（Qn）表示，分类变量以例数及百分比方式表示。多组间连续性变量比较采用方差分析或Kruskal-Wallis检验，分类变量采用，检验或Fisher确切概率法，若为单向有序分类变量，则选择Kruskal-Wallis检验。Kaplan-Meier法绘制生存曲线，生存情况的单因素分析采用Log-rank检验，多因素分析采用COX比例风险模型。结果（1）患者基本临床病理特征：343例肝癌患者中，B1、B2、B3／4组患者分别为143例、183例、17例（B3期12，B4期5例）。3组患者在年龄、腹腔积液、TBil、Alb、ALT、PT、PLT、AFP、肝切除范围、手术切缘侵犯、肿瘤直径、肿瘤数目、Edmondson-Steiner分级、Up-to-7评分、Up-to-7标准、Child-Pugh评分方面比较，差异有统计学�Objective To investigate the overall survival prediction of the Bolondi substaging model for patients in intermediate-stage of Barcelona clinic liver cancer （BCLC） after hepatectomy. Methods The retrospective cohort study was adopted. The clinical data of 343 patients with intermediate-stage hepatocellular carcinoma （HCC） who were admitted to the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University between February 2008 and January 2010 were collected. All the patients received the detailed medical history collection, physical examination, laboratory and imaging examinations after admission, and then hepatectomy was performed according to the results of above examinations. Research methods ： （ 1 ） patients were allocated into the B1, B2 and B3/4 groups based on the Boloudi＇s substaging model, and the prognostic analyses among groups were conducted. （2） The related factors affecting the prognosis of patients in the B1 and B2 groups were analyzed. （3） The patients in the B1 and B2 groups were allocated into the 4 groups [ patients of B1 group with negative microvascular invasion （MVI） were divided in the M1 group, patients of B1 group with positive MVI in the M2 group, patients of B2 group with negative MVI in the M3 group and patients of B2 group with positive MVI in the M4 group I according to the situations of MVI, and stratified analysis was conducted. Observation indicators： basic clinical and pathological features and survival of patients in the B1, B2 and B3/4 groups were observed. Risk factors analysis affecting the prognosis of patients and stratified analysis of MVI in the B1 and B2 groups were conducted. All the patients were followed up by outpatient examination and telephone interview up to February 2014, and the abdominal ultrasound, liver function and serum alpha-fetoprotein （AFP） tests was performed once every 3 months within 2 years postoperatively and once every 6 months after 2 years postoperatively. The continuous variables and catego

关 键 词：肝肿瘤 Bolondi再分期模型 预后 

分 类 号：R735.7[医药卫生—肿瘤]