微血管侵犯和解剖性肝切除对肝细胞癌患者肝切除术后早期复发和生存的影响  

Effects of microvascular invasion and anatomical hepatectomy on early recurrence and survival of patients with hepatocellular carcinoma

作　　者：师恒鑫 刘炎锋[2] 沈乃营 张毅 张小弟 王奔 蔡守旺[3] 杨世忠[4] Shi Hengxin;Liu Yanfeng;Shen Naiying;Zhang Yi;Zhang Xiaodi;Wang Ben;Cai Shouwang;Yang Shizhong(Department of Hepatobiliary-Pancreatic Surgery,No.215 Hospital of Shaanxi Nuclear Industry,Xianyang 712000,China;Department of Hepatobiliary-Pancreatic Surgery,Qilu Hospital of Shandong University,Jinan 250012,China;Department of Hepatobiliary-Pancreatic Surgery,the First Medical Center,Chinese People's Liberation Army(PLA)General Hospital,Beijing 100853,China;Hepatopancreatobiliary Center,Beijing Tsinghua Changgung Hospital,Institute for Precision Medicine,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)

机构地区：[1]陕西省核工业二一五医院肝胆胰外科,咸阳712000 [2]山东大学齐鲁医院肝胆胰外科,济南250012 [3]解放军总医院第一医学中心肝胆胰外科,北京100853 [4]清华大学附属北京清华长庚医院肝胆胰中心、清华大学精准医学研究院、清华大学临床医学院,北京102218

出　　处：《中华肝胆外科杂志》2023年第9期641-645,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金(82090052);清华大学精准医学科研项目(2022ZLA007);陕西省核工业二一五医院重点科研项目(215KYJJ-202201);陕西省核工业二一五医院一般科研项目(215KYJJ-202214)。

摘　　要：目的分析微血管侵犯(MVI)和解剖性肝切除对肝细胞癌患者肝切除手术后早期复发和生存的影响。方法回顾分析陕西省核工业二一五医院、解放军总医院、清华大学附属北京清华长庚医院2008年7月至2019年6月诊断为原发性肝细胞癌并行根治性切除的患者资料。共入组246例,其中男性208例,女性38例,年龄(53.8±9.6)岁。246例患者依据是否合并MVI分为伴MVI组(n=83)和对照组(n=163,无MVI)。比较两组乙型肝炎病毒感染、术前甲胎蛋白、肿瘤最大径、术中出血量等,比较倾向性评分逆概率加权校正前后无复发生存率和累积生存率。结果伴MVI组乙型肝炎病毒感染、甲胎蛋白>200μg/L比例和肿瘤最大径、术中出血量高于对照组,差异均有统计学意义(均P<0.05)。使用logistic回归模型计算倾向性评分,进行逆概率加权校正后得到的虚拟样本量为247例(伴MVI组82例,对照组165例)。解剖性肝切除患者(n=107)术后早期复发风险低于非解剖性肝切除患者(n=139)(单因素Cox回归分析HR=1.60,95%CI:1.06~2.42,P=0.020),但总体生存情况相近(单因素Cox回归分析HR=1.66,95%CI:0.80~3.42,P=0.200)。倾向性评分逆概率加权校正前,伴MVI组无复发生存率和累积生存率低于对照组。经倾向性评分逆概率加权校正后,伴MVI组无复发生存率低于对照组(单因素Cox回归分析HR=2.62,95%CI:1.61~4.27,P<0.001)。MVI组和对照组术后累积生存率比较,差异无统计学意义(单因素Cox回归分析HR=2.09,95%CI:0.89~4.93,P=0.050)。结论MVI与肝细胞癌患者术后早期复发相关,解剖性肝切除术后早期复发率低于非解剖性肝切除。Objective To analyze the effects of microvascular invasion(MVI)and anatomical hepatectomy on early recurrence and survival of patients with hepatocellular carcinoma(HCC).Methods The data of 246 patients with HCC admitted to 215 Hospital of Shaanxi Nuclear Industry,Chinese PLA General Hospital and Beijing Tsinghua Chang Gung Hospital from July 2008 to June 2019 were retrospectively analyzed,including 208 males and 38 females,aged(53.8±9.6)years.According to the occurrence of MVI,246 patients were divided into the MVI group(n=83)and control group(n=163,without MVI).Hepatitis B virus(HBV)infection,preoperative alpha-fetoprotein(AFP),maximum tumor diameter,intraoperative blood loss were compared between the two groups.The recurrence-free survival and cumulative survival were compared between the two groups before and after the inverse probability weighted correction for propensity score.Results The propensity score was calculated by logistic regression model.After inverse probability weighted correction,the virtual sample size was 247 cases(82 cases in MVI group and 165 cases in control group).The proportion of HBV infection,with a serum level of AFP>200μg/L,the maximum diameter of tumor and the intraoperative blood loss were higher in MVI group(all P<0.05).The risk of early recurrence in patients undergoing anatomical hepatectomy(n=107)was lower than that in patients undergoing non-anatomical hepatectomy(n=139)(univariate Cox regression analysis of HR=1.60,95%CI:1.06 to 2.42,P=0.020),but the overall survival was comparable(univariate Cox regression analysis of HR=1.66,95%CI:0.80 to 3.42,P=0.200).The recurrence-free survival(RFS)of MVI group was lower than that of the control group,and the postoperative cumulative survival rate was also lower before the inverse probability weighted correction of the tendency score.The RFS in MVI group was lower than that in control group after the tendency score was adjusted by inverse probability weighting(HR=2.62,95%CI:1.61 to 4.27,P<0.001).There was no significant difference in

关 键 词：癌 肝细胞 预后 微血管侵犯 解剖性肝切除 

分 类 号：R735.7[医药卫生—肿瘤]