影响原发性肝细胞肝癌切除术预后的多因素分析  

A clinical investigation on factors influencing the prognosis of primary liver cancer patients after hepatectomy

作　　者：季锡清[1] 李朝龙[1] 杨进城[1] 杨鸿魁[1] 刘兴国[1] 王孟龙[1] 林智琪[1] 

机构地区：[1]第一军医大学南方医院肝胆血管外科,广州510515

出　　处：《中华普通外科杂志》2004年第2期91-93,共3页Chinese Journal of General Surgery

摘　　要：目的探索影响原发性肝癌手术预后的因素。方法回顾性分析 1994～ 1998年我院收治 189例经病理证实原发性肝癌切除术 ,随访 5年以上 ,选择 2 2项临床、病理特征及治疗等指标分析对生存率、无瘤生存率的影响。结果全组 3、5年生存率为 6 3%和 4 5 % ,16 2例获得根治者 3、5年生存率及无瘤生存率分别为 6 7%、4 7%和 4 5 % ,2 6 % ;影响预后单因素为发现方式、瘤体大小、门静脉癌栓、肝癌结节数、肝硬化情况及结节类型、TNM分期、复发及复发后治疗方式、根治分类、分化程度、有无输血情况 (P =0～ 0 0 0 34) ;多因素分析表明 ,肝癌根治、肿瘤大小和复发后的治疗与生存率有显著相关性 (P =0～ 0 0 0 2 4 ) ;输血及肝硬化类型与无瘤生存率显著相关 (P =0 0 0 0 1)。结论根治分类、肿瘤大小 ,复发后再手术切除是影响预后的高风险因素。肝硬化严重程度与围手术期输血与术后无瘤生存率密切相关。Objective To explore factors influencing the prognosis of hepatocellular carcinoma (HCC) patients after hepatectomy. Methods From May 1994 to January 1998, 189 patients who underwent hepatectomy for HCC were enrolled for reviewing their clinical characteristics, treatment and prognosis. Twenty-two parameters contributing to long-term survival rate (SR) and disease-free SR were analysed. Results The 3,5-year cumulative SR of the whole group was 63%,45%, respectively. The 3,5-year SR and disease-free SR in the curative resection (CR) group ( n =162) were 67%,47% and 45%,26% respectively. Results showed that the way by which a tumor was found, tumor size, portal tumor thrombi, satellite nodule, TNM stage, cirrhosis type, recurrent and treatment, blood transfusion, differentiation grade,and CR were risk factors by individual variable analysis( P =0.0000～0.0034); A multivariable analysis showed that CR, tumor size, tumor finding mode and reoperation were significant factors associating with prognosis( P =0.0000～0.0024). Blood transfusion and type of cirrhosis were closely correlated with tumor-free survival ( P =0.0001). Conclusions Curative resection, tumor size, reoperation for recurrence were important factors for recurrence by multivariate analysis. The severity of concomittant liver cirrhosis and perioperative blood transfusion were closely correlated with postoperative tumor free survival.

关 键 词：影响因素 原发性肝细胞肝癌 切除术 预后 病理特征 

分 类 号：R735.7[医药卫生—肿瘤] R730.56[医药卫生—临床医学]