区域淋巴结转移对原发性肝细胞癌肝切除患者预后的影响  

Impact of regional lymph node metastasis on prognosis of patients with hepatocellular carcinomaafter hepatectomy

作　　者：孔杰 赵海旺[1] 李辉[1] 王琛[1] 徐权斌[1] 孙智勇[1] 叶永强[1] 

机构地区：[1]山东省菏泽市立医院肝胆外科,274000

出　　处：《中华肝胆外科杂志》2017年第12期809-813,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨区域淋巴结转移对原发性肝细胞癌（HCC）肝切除患者预后的影响。方法回顾性分析1999年1月至2013年12月在菏泽市立医院322例HCC肝切除术患者临床和随访资料。区域淋巴结转移的判定依据为术前影像学资料和术中所见。结果区域淋巴结转移者16例（5．0％），无淋巴转移者306例（95．0％）。区域淋巴结转移组1、2、5年总体生存率（OS）分别为43．8％、31．3％、7．5％；无区域转移组分别为83．7％、70．9％、46．1％（10g—rank检验P〈0．05）。区域淋巴结转移组1、2、5年无瘤生存率（DFS）分别为30．O％、22．5％、6．3％；无区域淋巴结转移组分别为69．8％、52．8％、34．5％（P〈0．05）。随访期间，区域淋巴结转移组中短期复发（≤6个月）者10例（71．4％）；无区域淋巴结转移组142例（31．6％，x。=9．754，P〈0．05）。单因素分析显示，无肝硬化、肝切除范围〉1段、最大瘤径〉5cm、组织学呈低分化和肿瘤包膜缺如是影响区域淋巴结转移组患者DFS的重要因素（P〈0．05）。Cox回归分析结果显示肿瘤包膜缺如为影响DFS的独立危险因素。结论区域淋巴结转移是影响HCC患者肝切除术预后的重要因素。切除转移淋巴结以及术后综合治疗对改善此类患者的预后、减少复发、提高长期生存率有积极意义。ObjectiveL To-study the impact of regional lymph node metastasis on the prognosis of patients with hepatocellular carcinoma （HCC） after hepatectomy. Methods Three hundred and twenty-two HCC patients who underwent elective hepatectomy in the Heze Municiple Hospital were retrospectively studied from January 1999 to December 2013. The clinical data and follow-up results were analyzed. The diagnosis of lymph node metastasis was based on preoperative imaging data and intraperative findings. Re- sults There were 16 patients （5.0%） with lymph node metastasis （ the metastasis group） and 306 patients （95.0%） without lymph node metastasis （ the no-metastasis group）. On Kaplan-Merier analysis, the overall survival （OS） rates at 1, 2, 5 years were 43.8%, 31.3%, 7.5% in the metastasis group and 83.7%, 70.9%, 46.1% in the no-metastasis group, respectively （ Log-rank test： P 〈 O. 05）. The corresponding disease-free survival （DFS） rates were 30. 0% , 22. 5% , 6. 3% in the metastasis group and 69. 8%, 52. 8%, 34. 5% in the no-metastasis group, respectively, （P 〈0.05）. On follow-up, the mid- and short- term HCC recurrence rates （ 〈6 months） were 71.4% in the metastasis group （ 10 patients） and 31.6% in the no-metastasis group （ 142 patients, x2 = 9. 754, P 〈 0.05 ）, respectively. Absence of cirrhosis, hepa- tectomy extent of 〉 1 Section, max-diameter of tumor 〉 5 cm, poor differentiation and absence of tumor en- capsulation were significant factors of DFS in the metastasis group （ P 〈 O. 05 ）. On COX regression analysis, absence of tumor encapsulation was the only independent risk factor of DFS. Conclusions Regional lymph node metastasis was one of the significant factors for OS and DFS in HCC patients who underwent hepatecto- my. Resection of metastatic lymph nodes and post-operation adjuvant treatment should be helpful to improve patients ＇ prognosis.

关 键 词：肝细胞癌 区域淋巴结转移 复发 肝切除 预后 

分 类 号：R735.7[医药卫生—肿瘤]