最大径≤5 cm小肝细胞癌患者肝切除术后预后因素分析

摘要

目的 探讨影响小肝细胞癌(最大径≤5 cm)患者肝切除术后预后的相关因素.方法 选取2003年12月年至2013年7月中国医学科学院肿瘤医院腹部外科手术治疗的219例小肝细胞癌患者资料,收集患者术前甲胎蛋白、肿瘤个数、肿瘤最大径、肝硬化情况、有无脉管瘤栓、肝被膜侵犯、癌细胞分化程度、手术切缘、手术方式及术中肝门血流阻断方式、术后治疗方式、复发情况及复发时间等临床资料.采用生存分析及Cox风险比例模型等分析影响患者预后的相关因素.结果 本组所有病例1、3、5、10年的累积生存率分别为95.9％、85.3％、67.8％、53.3％.单因素分析结果表明,脉管瘤栓、肝被膜侵犯、肿瘤最大径、肝血流阻断方式、是否有肝硬化、癌细胞分化程度、甲胎蛋白水平、术后治疗方式、复发情况及复发时间对患者预后有影响(P值均＜0.05).多因素分析结果表明,术前甲胎蛋白、肿瘤分化程度、是否有肝硬化、肝被膜侵犯、肿瘤最大径、复发情况及复发时间为影响小肝细胞癌术后预后的独立因素(P值均＜0.05).结论 术前甲胎蛋白水平高、肿瘤分化程度低、肝硬化程度重、肝被膜侵犯、肿瘤最大径大、有复发或复发早的小肝细胞癌患者预后差,对于高危复发患者应加强随访及干预,以提高肝细胞癌患者生存率.%Objective To explore the clinical and pathological factors influencing the prognosis of patients with hepatocellular carcinoma (HCC) (≤5 cm) after hepatectomy.Methods Two hundreds and nineteen cases with HCC(≤5 cm) undergoing hepatectomy in Cancer Hospital,Chinese Academy of Medical Sciences between December 2003 and July 2013 were collected.The alpha fetoprotein (AFP) level,tumor number,tumor size (diameter), liver cirrhosis, vascular invasion, capsular invasion, differentiation, surgical methods,resection margin, the way of treatments, the situation of recurrence and time to recurrence were analyzed.Log-rank test and the stepwise Cox proportional-hazards models were used to compare the prognosis,respectively.Results The 1-,3-,5-and 10-year overall survival rates were 95.9％ ,85.3％, 67.8％ and 53.3％ respectively in all patients.Single factor analysis indicated that vascular invasion, capsular invasion,tumor size, hepatic vascular occult, liver cirrhosis, tumor differentiation, AFP, the way of treatments,the situation of recurrence and time to recurrence can affect the prognosis significantly (all P ＜ 0.05).The muhifactor analysis showed that AFP, tumor differentiation, liver cirrhosis, capsular invasion, tumor size and the situation of recurrence and time to recurrence were independent prognostic factors (all P＜0.05).Condusion The prognosis of patients with HCC(≤5cm) underwent hepatectomyare affected by multi-factors, such as AFP, tumor differentiation, liver cirrhosis, capsular invasion,tumor size and the situation of recurrence and time to recurrence.