微血管侵犯阳性肝癌病人肝切除肿瘤复发的危险因素分析  

Analysis of the risk factors of tumor recurrence in hepatocellular carcinoma patients with positive microvascular invasion treated with hepatectomy

作　　者：苏展[1] 杨为中 车金辉 周武元 SU Zhan;YANG Wei-zhong;CHE Jin-hui;ZHOU Wu-yuan(Department of Hepatobiliary and Pancreatic Surgery,Xuzhou Cancer Hospital of Jiangsu,Xuzhou Jiangsu 221000,China)

机构地区：[1]江苏省徐州市肿瘤医院肝胆胰外科,221000

出　　处：《蚌埠医学院学报》2021年第1期87-90,共4页Journal of Bengbu Medical College

摘　　要：目的:研究微血管侵犯(MVI)阳性肝癌病人肝切除肿瘤复发的危险因素。方法:选择肝癌病人60例作为研究对象,根据手术病理结果分为MVI阳性组20例和MVI阴性组40例。比较2组病人一般资料、术后并发症发生情况和随访12个月的复发率、死亡率,分析MVI阳性肝癌病人肝切除肿瘤复发的危险因素。结果:MVI阳性组和MVI阴性组病人性别、年龄、病理类型、手术切缘、解剖性肝切除、肝硬化、肝炎、肝功能Child-Pugh分级差异均无统计学意义(P>0.05),2组肿瘤分化程度、肿瘤最大径、肿瘤边缘是否光滑、肿瘤包膜是否完整、甲胎蛋白水平差异均有统计学意义(P<0.05~P<0.01)。MVI阳性组病人术后并发症发生率为20.00%(4/20),与MVI阴性组的7.50%(3/40)比较差异无统计学意义(P>0.05)。随访12个月,MVI阳性组病人复发率25.00%(5/20),高于MVI阴性组的5.00%(2/40)(P<0.05);MVI阳性组病人死亡率10.00%(2/20),与MVI阴性组的5.00%(2/40)差异无统计学意义(P>0.05)。多因素logistic回归分析显示,肿瘤低分化、肿瘤最大径>5 cm、肿瘤边缘不光滑、无肿瘤包膜、甲胎蛋白水平>400μg/L均为MVI阳性肝癌的独立危险因素(P<0.05~P<0.01)。结论:MVI阳性肝癌病人肝切除后复发率比MVI阴性肝癌病人更高,且与肿瘤分化程度、肿瘤直径、肿瘤边缘及包膜、AFP相关。Objective:To study the risk factors for tumor recurrence in hepatocellular carcinoma patients with positive microvascular invasion(MVI)treated with hepatectomy.Methods:Sixty patients with liver cancer were divided into the MVI-positive group(20 cases)and MVI-negative group(40 cases)according to the surgical pathological results.The basic data,postoperative complications,and recurrence rate and mortality after 12-month of following-up were compared between two groups.The risk factors of tumor recurrence in hepatocellular carcinoma patients with positive MVI treated with hepatectomy were analyzed.Results:The differences of the gender,age,pathological type,surgical margin,anatomical hepatectomy,cirrhosis,hepatitis and liver function Child-Pugh classification between two groups were not statistically significant(P>0.05).The differences of the degree of tumor differentiation,maximum diameter of tumor,smooth edge of tumor,integrity of tumor envelope and level ofα-fetoprotein(AFP)were statistically significant(P<0.05 to P<0.01).The postoperative complication rate in the MVI-positive group and MVI-negative group were 20.00%and 7.50%,respectively,and the difference of which between two groups was not statistically significant(P>0.05).After 12 months of following-up,the recurrence rate of tumor in MVI-positive group(25.00%)was higher that in MVI-negative group(5.00%)(P<0.05).The difference of the mortality rate between the MVI-positive group(10.00%)and MVI-negative group(5.00%)was not statistically significant(P>0.05).The results of multivariate logistic regression analysis showed that the low differentiation,maximum diameter>5 cm,non-smooth edge,tumor-free capsule and AFP>400 g/L were the dependent risk factors of MVI-positive liver cancer(P<0.05 to P<0.01).Conclusions:The recurrence rate of MVI-positive liver cancer patients after hepatectomy is higher than that of MVI-negative liver cancer patients,and mainly related to the degree of tumor differentiation,tumor diameter,tumor margin,capsule and AFP level.

关 键 词：肝肿瘤 微血管侵犯 肝切除术 肿瘤复发 手术切缘 肿瘤包膜 

分 类 号：R735.7[医药卫生—肿瘤]