肝组织内乙型肝炎表面抗原阳性对肝细胞癌术后复发的影响  

The influence of HBsAg expression in liver tissue on the postoperative recurrence of HCC patients

作　　者：李巧媚 周华邦 胡和平 黄渊[3] 赵欢 杨上文 Li Qiaomei;Zhou Huabang;Hu Heping;Huang Yuan;Zhao Huan;Yang Shangwen(Department of Gastroenterology,Lishui Central Hospital,the Fifth Affiliated Hospital of Wenzhou Medical University,Lishui 323000,China;Department of Hepatobiliary,Eastern Hepatobiliary Surgery Hospital,Second Military Medical University,Shanghai 200438,China;Department of Pathology,Lishui Central Hospital,the Fifth Affiliated Hospital of Wenzhou Medical University,Lishui 323000,China)

机构地区：[1]温州医科大学附属第五医院丽水市中心医院消化内科,丽水323000 [2]第二军医大学第三附属医院上海东方肝胆外科医院肝胆内科,上海200438 [3]温州医科大学附属第五医院丽水市中心医院病理科,丽水323000

出　　处：《中华肿瘤杂志》2022年第4期347-353,共7页Chinese Journal of Oncology

摘　　要：目的探讨乙型肝炎病毒(HBV)相关肝细胞癌(HCC)患者癌旁组织中乙型肝炎表面抗原(HBsAg)表达对HCC根治性切除术后复发的影响。方法选取2009年10月至2010年8月于上海东方肝胆外科医院治疗的HCC患者, 收集718例患者的临床病理资料及癌旁组织, 采用葡聚糖聚合物免疫组化染色检测癌旁组织中HBsAg的表达, 根据癌旁组织中HBsAg的表达分为HBsAg阳性组和HBsAg阴性组。生存分析采用Kaplan-Meier法和Log rank检验, 多因素分析采用Cox回归模型。结果全组718例患者中, HBsAg阴性153例, HBsAg阳性565例。HBsAg阴性组患者血清HBV DNA≥2 000 IU/ml和<2 000 IU/ml的患者分别为52和93例, HBsAg阳性组分别为325和205例, 差异有统计学意义(P<0.001)。全组患者术后1、3、5年累积复发率分别为30.2%、54.3%和62.7%, HBsAg表达情况与复发有关(P=0.038)。多因素分析显示, γ-谷氨酰转肽酶、凝血酶原时间、肿瘤多发、肿瘤长径、门静脉侵犯是影响HCC术后复发的独立危险因素(均P<0.05)。乙型肝炎e抗原阴性低病毒载量(HBV DNA<2 000 IU/ml)同时无肝硬化患者中, HBsAg阳性患者术后3、5年复发率分别为14.3%和31.0%, 与HBsAg阴性患者(均为0)比较, 差异有统计学意义(P=0.021)。结论癌旁组织HBsAg阳性表达增加HCC患者术后复发风险。Objective To investigate the influence of HBsAg expression in peritumoral tissue of hepatocellular carcinoma(HCC)patients on their postoperative recurrence.Methods The HCC patients treated in Shanghai Eastern Hepatobiliary Surgery Hospital from October 2009 to August 2010 were selected.The clinicopathological data and adjacent tissues of 718 patients were collected,and dextran polymer immunohistochemical staining was used to detect the expression of HBsAg in adjacent tissues.According to the expression of HBsAg in adjacent tissues,the tissues were divided into HBsAg positive group and HBsAg negative group.Kaplan-Meier method and Log rank test were used for survival analysis,and Cox regression model was used for multivariate analysis.Results Among the 718 patients in the whole group,153 were HBsAg negative and 565 were HBsAg positive.There was a statistically significant difference in serum HBV DNA level between HBsAg-positive and HBsAg-negative patients(P<0.001).The number of patients with serum DNA≥2000 IU/ml and<2000 IU/ml in HBsAg negative group were 52 and 93,while the patients in HBsAg positive group were 325 and 205.The cumulative recurrence rates of all patients at 1,3,and 5 years after surgery were 30.2%,54.3%,and 62.7%,respectively.The expression of HBsAg was related to the recurrence(P=0.038).Multivariate analysis showed thatγ-GT,PT,multiple tumors,tumor length,and portal vein invasion were independent risk factors for recurrence of HCC(P<0.05).In HBeAg-negative patients with low viral load(HBV DNA<2000 IU/ml)and without cirrhosis,the recurrence rates of HBsAg-positive patients were 14.3%and 31.0%at 3 and 5 years,respectively,compared with HBsAg negative patients(all 0),the difference was statistically significant(P=0.021).Conclusion The positive expression of HBsAg in peritumoral tissue increases the postoperative recurrence risk of HCC patients.

关 键 词：肝肿瘤 乙型肝炎表面抗原 癌旁组织 复发 

分 类 号：R735.7[医药卫生—肿瘤]