微血管侵犯及手术切缘对肝细胞癌患者术后生存预后的影响  

Effect of microvascular invasion and surgical margin on postoperative survival and prognosis of patients with hepatocellular carcinoma

作　　者：王礼光 严庆 廖珊[2] 符荣党 陈焕伟 Liguang Wang;Qing Yan;Shan Liao;Rongdang Fu;Huanwei Chen(The First Clinical Medical College of Guangdong Medical University,Zhanjiang 524001,China;Department of Hepatobiliary and Pancreatic Surgery,the First People's Hospital of Foshan,Foshan 528010,China)

机构地区：[1]广东医科大学第一临床学院,广东省湛江市5240001 [2]广东省佛山市第一人民医院肝脏胰腺外科,528010

出　　处：《中华肝脏外科手术学电子杂志》2024年第2期151-157,共7页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省自然科学基金重点项目(2020A1515110073);广东省科学技术奖培育项目(2020001003307);肝癌的微创诊疗技术及基础研究创新平台建设(2016AG100561)。

摘　　要：目的:探讨微血管侵犯(MVI)及手术切缘对肝细胞癌(HCC)术后生存预后的影响。方法:回顾性分析2016年1月至2020年12月佛山市第一人民医院收治的513例HCC肝切除患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男419例,女94例;年龄25~86岁,中位年龄54岁。MVI分为3个等级:M0(无MVI组)、M1(低危组)、M2(高危组)。肿瘤切缘分为窄切缘(<1 cm)、宽切缘(≥1 cm)。采用χ^(2)检验及Logistic回归多因素分析HCC患者MVI发生的影响因素。生存分析采用Kaplan-Meier法和Log-rank检验。结果:单因素分析显示,AFP、肿瘤直径、肿瘤数目、CNCL与HCC患者MVI发生有关(χ^(2)=28.068,29.657,4.375,10.208;P<0.05)。Logistic回归多因素分析显示,AFP、肿瘤直径是HCC患者MVI发生的独立影响因素(OR=0.408,0.394;P<0.05)。M0组术后1、2、3年无瘤生存率分别为79.6%、71.0%、63.4%,M1组相应为59.6%、48.0%、43.3%,M2组相应为31.0%、27.5%、25.2%,差异有统计学意义(χ^(2)=61.889,P<0.05)。M0组术后1、2、3年总体生存率分别为97.3%、88.2%、84.6%,M1组相应为87.0%、71.5%、66.1%,M2组相应为79.3%、61.9%、52.6%,差异有统计学意义(χ^(2)=44.138,P<0.05)。对于MVI阴性患者,宽切缘组术后1、2、3年无瘤生存率分别为82.6%、70.7%、65.4%,而窄切缘组相应为79.4%、64.7%、60.5%,差异无统计学意义(χ^(2)=0.983,P>0.05);宽切缘组术后1、2、3年总体生存率分别为97.5%、89.6%、85.2%,而窄切缘组相应为97.1%、86.0%、82.8%,差异无统计学意义(χ^(2)=0.051,P>0.05)。对于MVI阳性患者,宽切缘组术后1、2、3年无瘤生存率分别为58.1%、45.4%、40.3%,而窄切缘组相应为42.9%、37.3%、36.1%,差异有统计学意义(χ^(2)=4.874,P<0.05);宽切缘组术后1、2、3年总体生存率分别为88.8%、71.9%、64.3%,窄切缘组相应为82.6%、64.8%、61.0%,差异有统计学意义(χ^(2)=4.604,P<0.05)。结论:肿瘤大小、AFP是HCC患者发生MVI的独立危险因素。MVI分级�Objective To evaluate the effect of microvascular invasion(MVI)and surgical margin on postoperative survival and prognosis of hepatocellular carcinoma(HCC)patients.Methods Clinical data of 513 patients with HCC admitted to the First People's Hospital of Foshan from January 2016 to December 2020 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,419 patients were male and 94 female,aged from 25 to 86 years,with a median age of 54 years.MVI was divided into three grades:M0(non-MVI group),M1(low-risk group)and M2(high-risk group).The tumor surgical margin was divided into narrow surgical margin(<1 cm)and wide surgical margin(≥1 cm).The influencing factors of MVI in HCC patients were identified by Chi-square test and Logistic regression analysis.Survival analysis was conducted by Kaplan-Meier method and Log-rank test.Results Univariate analysis showed that AFP,tumor diameter,number of tumors and China liver cancer(CNLC)staging system were correlated with the incidence of MVI in HCC patients(χ^(2)=28.068,29.657,4.375,10.208;P<0.05).Multivariate Logistic regression analysis showed that AFP and tumor diameter were the independent influencing factors of MVI in HCC patients(OR=0.408,0.394;P<0.05).In the M0 group,the postoperative 1-,2-and 3-year disease-free survival rates were 79.6%,71.0%and 63.4%,and 59.6%,48.0%and 43.3%in the M1 group,and 31.0%,27.5%and 25.2%in theM2 group,respectively.The differences were statistically significant(χ^(2)=61.889,P<0.05).In the M0 group,the postoperative 1-,2-and 3-year overall survival rates were 97.3%,88.2%and 84.6%,87.0%,71.5%and 66.1%in the M1 group,and 79.3%,61.9%and 52.6%in the M2 group,respectively.The differences were statistically significant(χ^(2)=44.138,P<0.05).For MVI-negative patients,the postoperative 1-,2-and 3-year disease-free survival rates in the wide margin group were 82.6%,70.7%and 65.4%,and 79.4%,64.7%and 60.5%in the narrow margin group,with no statistical significan

关 键 词：癌 肝细胞 微血管侵犯 肝切除术 手术切缘 生存分析 预后 

分 类 号：R735.7[医药卫生—肿瘤]