糖尿病对不同TNM分期肝细胞癌术后预后的影响  

Prognostic effects of type 2 diabetes mellitus on patients with different TNM stage of hepatocellular carcinoma after operation

作　　者：李晓燕 刘文迪 王芃 汪慧 邹珊珊 周华邦 胡和平 Li Xiaoyan;Liu Wendi;Wang Peng;Wang Hui;Zou Shanshan;Zhou Huabang;Hu Heping(Department of Hepatobiliary Internal Medicine,Eastern Hepatobiliary Surgery Hospital,Naval Medical University,Shanghai 200438,China)

机构地区：[1]海军军医大学东方肝胆外科医院肝胆内科,上海200438

出　　处：《中华消化杂志》2022年第1期19-24,共6页Chinese Journal of Digestion

基　　金：国家自然科学基金(81672371)。

摘　　要：目的探讨2型糖尿病(T2DM)对肝细胞癌患者临床病理特征及其根治术后预后的影响。方法回顾性分析2009年11月至2011年6月在海军军医大学东方肝胆外科医院行根治性切除术的肝细胞癌患者的临床病理和生存资料。根据是否合并T2DM将患者分为T2DM组与无T2DM组,比较2组患者的临床病理特征和预后情况。统计学方法采用卡方检验或Fisher确切概率法。采用Kaplan-Meier法进行单因素生存分析,采用Cox比例风险回归模型进行多因素生存分析。结果共1691例肝细胞癌患者入组,其中142例(8.4%)患者合并T2DM。T2DM组患者中肝细胞癌发病年龄≥65岁的患者占比、男性占比、合并高血压病者占比、γ-谷氨酰转肽酶>61 U/L的患者占比均高于无T2DM组[24.6%(35/142)比10.4%(161/1549)、92.3%(131/142)比85.7%(1327/1549)、43.7%(62/142)比12.3%(191/1549)、58.5%(83/142)比49.4%(765/1549)],合并慢性肝炎病毒感染者占比、甲胎蛋白>20μg/L的患者占比均低于无T2DM组[76.1%(108/142)比92.0%(1425/1549)、47.2%(67/142)比59.9%(928/1549)],差异均有统计学意义(χ^(2)=25.79、4.75、100.36、4.28、39.01、8.66,均P<0.05)。单因素生存分析显示,T2DM组与无T2DM组肝细胞癌患者的术后总生存率比较差异无统计学意义(χ^(2)=3.02,P=0.082);进一步亚组分析显示,在病理TNM分期Ⅰ期的肝细胞癌患者中,T2DM组与无T2DM组患者的术后总生存率比较差异有统计学意义(χ^(2)=4.53,P=0.033),T2DM组患者的术后1、3、5年总生存率均低于无T2DM组[96.0%(48/50)比97.6%(558/572)、78.0%(39/50)比88.6%(507/572)、68.0%(34/50)比79.5%(455/572)]。多因素Cox回归分析显示,合并T2DM是病理TNM分期Ⅰ期肝细胞癌患者术后生存的独立危险因素之一(OR值=1.663,95%置信区间1.045~2.648,P=0.032)。结论T2DM对肝细胞癌根治性切除术后患者预后的影响与TNM分期密切相关,其影响可能仅限于肝细胞癌的早期阶段。Objective To investigate the effects of type 2 diabetes mellitus(T2DM)on the clinicopathological characteristics and prognosis of patients with hepatocellular carcinoma(HCC)after curative hepatectomy.Methods From November 2009 to June 2011,the clinicopathological and survival data of HCC patients who underwent radical resection at Eastern Hepatobiliary Surgery Hospital of Naval Medical University were retrospectively analyzed.The patients were divided into T2DM group and non-T2DM group.Clinicopathological characteristics and prognosis of two groups were compared.Chi square test or Fisher exact test were used for statistical analysis.Kaplan-Meier test was used for univariate survival analysis,and Cox proportional hazard regression model was used for multivariate survival analysis.Results A total of 1691 patients with HCC were enrolled in this study.Among them,142 patients(8.4%)were complicated with T2DM.The proportion of patients with onset age≥65 years old,the proportion of men,the proportion of patients with hypertension and γ-glutamyltranspeptidase>61 U/L in the T2DM group were higher than those in non-T2DM group(24.6%,35/142 vs.10.4%,161/1549;92.3%,131/142 vs.85.7%,1327/1549;43.7%,62/142 vs.12.3%,191/1549;58.5%,83/142 vs.49.4%,765/1549),while the proportion of patients with chronic hepatitis virus infection andα-fetoprotein>20μg/L in the T2DM group were both lower than those in non-T2DM group(76.1%,108/142 vs.92.0%,1425/1549;47.2%,67/142 vs.59.9%,928/1549),and the differences were all statistically significant(χ^(2)=25.79,4.75,100.36,4.28,39.01 and 8.66,all P<0.05).The results of univariate survival analysis showed that there was no significant difference in the postoperative overall survival(OS)rate between T2DM group and non-T2DM group(χ^(2)=3.02,P=0.082).The results of further subgroup analysis showed that among HCC patients with TNM stageⅠ,there was statistically significant difference in the OS rate between T2DM group and non-T2DM group(χ^(2)=4.53,P=0.033).The OS rates at 1 year,3 years and 5 ye

关 键 词：癌 肝细胞 糖尿病 2型 肿瘤淋巴结转移 术后 预后 

分 类 号：R735.7[医药卫生—肿瘤] R587.1[医药卫生—临床医学]