直径大于8 cm单发肝细胞癌手术切除患者的生存影响因素  

Influencing factors for survival of patients after resection of single hepatocellular carcinoma with the diameter >8 cm

作　　者：田涛[1] 李鹏鹏[1] 王孟超[1] 黄健[1] 王志恒[1] 杨云[1] 杨远[1] 黄罡[1] 周伟平[1] 吴孟超[1] 

机构地区：[1]第二军医大学附属东方肝胆外科医院肝外三科,上海200438

出　　处：《中华肝脏外科手术学电子杂志》2017年第3期197-202,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家重点基础研究发展计划(973计划)(2014CB542102);国家自然科学基金创新研究群体项目(81521091)

摘　　要：目的探讨直径大于8 cm单发肝细胞癌(肝癌)手术切除患者的生存影响因素。方法回顾性分析2009年1月至2011年12月在第二军医大学附属东方肝胆外科医院行手术切除的417例直径大于8 cm单发肝癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男374例,女43例;年龄17~83岁,中位年龄54岁。采用Kaplan-Meier法分析患者术后无瘤生存率及总生存率,Cox比例风险回归模型分析影响肿瘤复发和患者术后生存的因素。结果患者术后1、2、3、5年无瘤生存率和总生存率分别为46.1%、34.8%、27.5%、16.6%和62.8%、47.7%、41.1%、29.2%。术前HBV-DNA>200 k U/L、术前AFP>400μg/L、肝硬化、镜下子灶、微血管侵犯为影响肿瘤复发的独立危险因素(HR=1.421,1.527,1.368,1.481,1.386;P<0.05)。术前HBV-DNA>200 k U/L、术前AFP>400μg/L、术中出血量>400 ml、肝硬化、镜下子灶、微血管侵犯为影响患者术后生存的独立危险因素(HR=1.389,1.406,1.450,1.521,1.631,1.714;P<0.05)。结论术前HBV-DNA、术前AFP、术中出血量、肝硬化、镜下子灶、微血管侵犯为影响直径大于8 cm单发肝癌手术切除患者术后生存的独立影响因素。术前应积极行抗病毒治疗,术中减少出血,尽量根治性切除以降低复发率,改善患者术后生存。Objective To investigate the influencing factors for survival of patients after resection of single hepatocellular carcinoma （HCC） with the diameter〉8 cm. Methods Clinical data of 417 patients with single HCC〉8 cm who underwent surgical resection in the Eastern Hepatobiliary Surgery Hospital affiliated to the Second Military Medical University between January 2009 and December 2011 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 374 cases were males and 43 females, aged 17-83 years old with a median age of 54 years old. The postoperative tumor-free survival rate and overall survival rate were analyzed using Kaplan-Meier method. The influencing factors for tumor recurrence and postoperative survival of the patients were analyzed using Cox＇s proportional hazards regression model. Results The postoperative 1-, 2-, 3-, 5-year tumor-free survival rate was respectively 46.1%, 34.8%, 27.5% and 16.6%, and the overall survival rate was respectively 62.8%, 47.7%, 41.1% and 29.2%. Preoperative HBV-DNA〉200 kU/L, preoperative AFP〉400 μg/L, liver cirrhosis, microscope satellite lesions and microvascular invasion were the independent risk factors for tumor recurrence （HR=1.421, 1.527, 1.368, 1.481, 1.386; P〈0.05）. Preoperative HBV-DNA〉200 kU/L, preoperative AFP〉400 μg/L, intraoperative blood loss〉400 ml, liver cirrhosis, microscope satellite lesions and microvascular invasion were the independent risk factors for postoperative survival （HR=1.389, 1.406, 1.450, 1.521, 1.631, 1.714; P〈0.05）. Conclusions Preoperative HBV-DNA, preoperative AFP, intraoperative blood loss, liver cirrhosis, microscope satellite lesions and microvascular invasion are the independent influencing factors for the survival of patients after resection of single HCC with the diameter〉8 cm. Anti-virus treatment should be actively implemented before surgery, the intraoperative blood loss should be reduced and radical resecti

关 键 词：癌 肝细胞 肝切除术 抗病毒治疗 微血管侵犯 复发 存活率 危险因素 

分 类 号：R735.7[医药卫生—肿瘤]