HBsAg阳性肝细胞癌行介入术后复发的相关因素分析  

Analysis on correlative factors of recurrence of HBsAg positive hepatocellular carcinoma after intervention operation

作　　者：张佳佳[1] 王佳[1] 顾心雨 胡春玲[1] 李华[1] 闫静雅[1] 曾庆磊[1] 武淑环[1] 余祖江[1] 李志勤[1] 

机构地区：[1]郑州大学第一附属医院感染科,450052

出　　处：《中国实用医刊》2017年第21期17-19,共3页Chinese Journal of Practical Medicine

摘　　要：目的探讨HBsAg阳性肝细胞癌（HCC）患者介入术后肿瘤复发的相关危险因素。方法回顾性分析85例HBsAg阳性HCC患者的临床特征，寻找肝癌复发的相关因素。运用Kaplan-Meier法计算HCC患者介入术后的生存率，绘制各预测因素水平下患者的生存曲线。应用Log-rank test及Forward Conditional Cox回归分析对预测因素进行单因素分析和多因素分析。结果85例患者介入术后每2-3个月随访1次，复发45例，无复发40例。单因素分析结果显示HCC患者介入术后复发的相关危险因素为：年龄〉50岁（F=25.860，P=0.047），TNM分期Ⅱ-Ⅲ期（F=178.218，P=0.0001），肿瘤数目〉2个（F=21.479，P=0.019），肿瘤最大直径〉5 cm（F=26.351，P=0.0001），术前血清甲胎蛋白（AFP）浓度〉400 ng/ml（F=19.113，P=0.0001），肝功能Child-Pugh分级B、C级（F=23.167，P=0.050），有门静脉血栓（F=33.333，P=0.0001），有周围血管侵犯（F=33.000，P=0.0001），有门静脉及肝外转移（F=67.667，P=0.0001）。多因素分析结果显示复发的独立危险因素为：肿瘤的病理分级差（RR=0.058，P=0.041）、有门静脉及肝外转移（RR=12.230，P=0.001）、侵犯周围血管（RR=7.238，P=0.0001）。结论HCC患者介入术后肝癌复发的主要危险因素为肿瘤的病理分级差、有门静脉及肝外转移、侵犯周围血管。掌握HCC复发因素可为临床医生把握介入手术适应证提供依据，从而提高HCC患者介入手术治愈率。Objective To investigate the prognostic factors of the recurrence of hepatocellular carcinoma（HCC） after intervention operation. Methods The preoperative data of 85 patients with HBsAg positive HCC who experienced intervention operation were retrospectively analyzed. Survival rates were calculated by Kaplan-Meier method. The disease-free survival curves of different prognostic factors were plotted by Kaplan-Meier method. Prognostic factors were analyzed by Log-rank test and Forward Conditional Cox regression respectively to yield the related risk factors and independent risk factors of the recurrence of HCC after intervention operation.Results Eighty-five patients were followed up for every 2-3 months, recurrence occured in 45 patients and 40 patients did not get recurrence. Univariate analysis with Log-rank test revealed that the following prognostic factors were significant： age〉50 years（F=25.860, P=0.047）, TNM stages of Ⅱ-Ⅲ （F=178.218, P=0.0001）, number of tumor ≥2（F=21.479, P=0.019）, the diameter of the largest viable tumor 〉5 cm （F=26.351, P=0.0001）, serum a-fetoprotein level〉400 ng/ml （F=19.113, P=0.0001）, liver function of grade B and C Child-Pugh （F=23.167, P=0.050）, invasive large blood vessels （F=33.000, P=0.0001）, distant metastasis （F=67.667, P=0.0001） and intrahepatic portal venous thrombosis （F=33.333, P=0.0001）. Multivariate analysis revealed that the independent prognostic factors include： histological differentiation （RR=0.058, P=0.041）, invasive large blood vessels （RR=7.238, P=0.0001） and portal venous and extrahepatic metastasis （RR=12.230, P=0.001）.Conclusions Poor histological differentiation, invasive large blood vessels and portal venous and extrahepatic metastasis were significant risk factors. Understanding the recurrence factors of HCC can provide reference for clinician to assure the indication of intervention treatment, so as to improve the recovery rate of intervention operation of HCC.

关 键 词：肝细胞癌 复发 介入手术 

分 类 号：R735.7[医药卫生—肿瘤]