多结节原发性肝癌患者根治切除术后短期复发的危险因素

摘要

目的 探讨多结节原发性肝细胞癌(HCC)患者根治切除术后短期复发的危险因素.方法 回顾性分析自2000年1月至2011年12月期间在青岛大学附属医院行根治性切除术的692例HCC患者的临床和随访资料.多结节的判定依据术前影像学资料和术中所见.结果 692例患者中有126例为多结节HCC(18.2％,多结节组),566例为单结节HCC(71.8％,单结节组).多结节组l、2、5和10年总体生存率(OS)分别为86.5％、72.2％、38.1％和23.2％,单结节组分别为93.8％、82.7％、58.2％和35.7％,log-rank检验P＜0.05.多结节组1、2、5和10年无瘤生存率(DFS)分别为68.6％、46.8％、27.2％和19.8％,单结节组分别为80.2％、62.1％、42.0％和34.6％ (P ＜0.05).Cox回归模型分析显示最大结节直径＞5 cm是影响多结节HCC患者根治性切除术后短期复发的独立危险因素.结论 多结节HCC患者根治性切除术后短期复发率明显高于单结节HCC组.最大结节直径是影响多结节HCC患者根治性切除术后短期复发的主要危险因素.尤其是最大结节直径＞5 cm时,其差异具有显著统计学意义,是影响多结节HCC患者根治性切除术后短期复发的独立危险因素.对于最大结节直径＞5 cm的多结节HCC患者,应更加重视围手术期管理和多学科诊疗模式(MDT)治疗.%Objective To investigate the relationship between primary hepatocellular carcinoma (HCC) with multiple nodules and short-term recurrence after radical resection.Methods We retrospectively analyzed the clinical data and follow-up of 692 consecutive HCC patients who underwent curative resection at the Affiliated Hospital of Qingdao University from January 2000 to December 2011.The diagnosis of multiple nodules was based on preoperative imaging data and observations in operation.Results Of 692 HCC patients, 126 patients had multiple nodules (18.2％, the MN group) and 566 patients had a single nodule (71.8％, the SN group).The 1-, 2-, 5-, and 10-year overall survival (OS) rates were 86.5％,72.2％, 38.1％, and 23.2％ for the MN group, and 93.8％, 82.7％, 58.2％, and 35.7％ for the SN group, respectively (P ＜ 0.05).The 1-, 2-, 5-, and 10-year disease-free survival (DFS) rates were 68.6％, 46.8％, 27.2％, and 19.8％ for the MN group, and 80.2％, 62.1％, 42.0％, and 34.6％ for the SN group, respectively (P ＜ 0.05).Cox regression model analysis showed a maximum nodule diameter of ＞ 5 cm was an independent risk factor of short-term recurrence in the MN group.Conclusions The prognosis of HCC patients with multiple nodules after radical resection was poorer and the short-term recurrence rate was significantly higher than those patients with a single-nodule.A maximum nodal diameter of ＞ 5 cm was an independent risk factor of short-term recurrence for patients with multiple nodules after radical resection.Therefore, patients with multiple nodules, especially ＞ 5 cm, should be followed up closely and they are good candidates for a multiple disciplinary team (MDT) treatment.