原发性肝癌切除术后早期复发高危因素分析

Analysis of risk factors for early recurrence of primary hepatocellular carcinoma after radical hepatectomy

目的探讨影响原发性肝癌根治性切除术后早期复发的高危因素。方法回顾性分析2000年6月至2002年12月广西医科大学第一附属医院经根治性手术切除的145例原发性肝癌的临床病理资料,选择16项临床、病理和治疗等指标分析其对早期复发的影响。结果全组1年内早期复发57例,早期复发组的1年存活率为36.8%,3年存活率为3.5%,而对照组(1年后复发或随访期间无复发)1年和3年存活率分别为100%和63.6%,两组存活率差异有统计学意义(χ2=139.9,P<0.001)。单因素分析表明,年龄、肝硬化、肿瘤直径、多发肿瘤、肿瘤包膜形成、肿瘤包膜浸润、门静脉癌栓、肝静脉癌栓、微血管浸润和肿瘤Edmond-Steiner分级是影响肝癌早期复发的高危因素。多因素分析提示,肿瘤直径、门静脉癌栓、肿瘤微血管浸润和肿瘤包膜浸润是影响肝癌早期复发的独立因素。结论术后复发是肝癌的一大生物学特性,肿瘤直径、门静脉癌栓、微血管浸润和肿瘤包膜浸润是影响肝癌早期复发的最主要危险因素。甄别肝癌切除术后早期复发的高危因素对于手术适应证的把握和术后的辅助治疗有指导性意义。

Objective To explore the risk factors for early recurrence of primary hepatocellular carcinoma after radical hepatectomy. Methods The clinical data of 145 cases of hepatocellular carcinoma performed radical hepatectomy from June 2000 to December 2002 at the First Affiliated Hospital of Guangxi Medical University were analyzed retrospectively. Sixteen factors involved in clinic, pathology and treatment were analyzed to determine their impact upon early recurrence of hepatocellular carcinoma. Results Fifty-seven cases underwent early recurrence within one year after hepatectomy. The survival rate of 1 and 3 years in early recurrence group was 36.8% and 3.5%, respectively. The survival rate of 1 and 3 years in control group （relapse one year after hepatectomy or relapse-free during follow-up） was 100% and 63.6%, respectively. The significant difference of survival rate exist between the two groups （Х^2=139.9, P〈 0.001）.The univariate analysis showed that age, liver cirrhosis, tumor diameter, multiple tumor, tumor capsule formation, tumor capsule invasion, portal vein tumor thrombus, hepatic vein tumor thrombus, microvessel invasion and tumor Edmond-Steiner grade were high risk factors for early recurrence of hepatocellular carcinoma after hepatectomy. Meanwhile, multivariate analysis indicated that tumor diameter, portal vein tumor thrombus, microvessel invasion and tumor capsule invasion were independent factors for early recurrence. Conclusion Recurrence after hepatectomy is one of main biology properties of hepatocellular carcinoma. Tumor diameter, portal vein tumor thrombus, microvessel invasion and tumor capsule invasion are main high risk factors for early recurrence. Identifing the high risk factors associated with early recurrence contributes to the grasp of operation indication and guidance of adjunctive therapy.