合并红细胞增多症对肝细胞癌手术患者预后的影响  

The prognostic impact of paraneoplastic erythrocytosis on patients with hepatocellular carcinoma after partial hepatectomy

作　　者：陈斌 冯旭卓 张杰[1] 齐亚鹏 马良[1] 袁卫平[1] 向邦德[1] 黎乐群[1] Chen Bin , Feng Xuzhuo, Zhang Jie, Qi Yapeng, Ma Liang, Yuan Weiping, Xiang Bangde, Li Lequn.(Department of Hepatobiliary Surgery, The Affiliated Cancer Hospital of Guangxi Medical University, Nanning 530021, Chin)

机构地区：[1]广西医科大学附属肿瘤医院肝胆外科,南宁530021 [2]南华大学附属第二医院

出　　处：《中华肝胆外科杂志》2018年第3期184-188,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金（81260331）

摘　　要：目的评价肝细胞癌（HCC）合并红细胞增多症（PE）对患者手术预后的影响。方法回顾性分析广西医科大学附属肿瘤医院713例接受HCC切除手术治疗的患者资料。其中合并红细胞增多症的患者（PE组）81例，未合并红细胞增多症的患者（非PE组）632例。倾向性评分匹配（PSM）法均衡组问协变量后，采用Kaplan-Meier法比较两组患者术后总生存率，并用Cox回归分析影响预后的风险因素。结果两组共有80对匹配成功，组间协变量达到均衡。分析显示：匹配后PE组的生存状况明显好于非PE组，两组患者术后1、3、5年总生存率分别为88．6％、74．2％、69．0％和91．0％、60．1％、41．6％，差异有统计学意义（P〈0．05）。单因素分析显示BCLC分期c期、大血管侵犯、肿瘤直径≥10cm、红细胞增多症、肿瘤包膜完整为影响HCC患者手术预后的危险因素（p〈0．05）。多因素分析结果表明：肿瘤直径≥10cm、BCLC分期C期是影响HCC患者术后总体生存时间的独立危险因素（均P〈0．05），而肿瘤包膜完整、PE则为独立保护性因素（P〈0．05）。结论对于可手术治疗的HCC患者，在肿瘤负荷相近的情况下，合并红细胞增多症的患者较不伴红细胞增多症的患者手术预后更好。PE是HCC患者预后的独立保护因素。Objective To retrospectively study-the prognostic impact of paraneoplastie erythrocyto- sis （PE） on patients with hepatocellular carcinoma （HCC） after liver resection. Methods 713 patients with HCC who underwent partial hepatic resection in The Affiliated Cancer Hospital of Guangxi Medical University were divided into two groups： the PE group （n = 81 ） and the non-PE group （n =632）. The overall survival between the two groups were compared after reducing confounding bias by using propensity score matching （PSM）. Independent prognostic predictors were determined by the Cox proportional hazards model. Results 80 pairs of patients were matched using PSM. In the matched cohort, the PE group exhibi- ted significantly longer overall survival （OS） compared to the NPE group of patients without erythrocytosis. The 1-, 3-, and 5-year overall survival rates were 88.6% , 74. 2% , 69. 0% in the PE group, and 91.0% , 60. 1% , 41.6% in the non-PE group, respectively （P 〈 0. 05）. Using the log-rank test, tumor size ≥ 10 cm, macrovascular invasion, Barcelona Clinic Liver Cancer （ BCLC ） stage C, PE and complete tumor en- capsulation were significantly associated with OS in patients with HCC after liver resection. The Cox regres- sion analysis indicated that tumor size ≥ 10 cm, and Barcelona Clinic Liver Cancer （BCLC） stage C were independent prognostic factors of poor prognosis, while complete tumor encapsulation and paraneoplastic erythrocytosis were independent predictors of good prognosis. Condusions For patients with HCC who un- derwent surgical resection, patients with PE had better prognosis than those without PE under the condition of similar tumor burden. PE was an independent predictor of good prognosis.

关 键 词：肝细胞癌 红细胞增多症 伴癌综合征 肝切除术 预后 

分 类 号：R735.7[医药卫生—肿瘤]