肝细胞癌患者肝切除术后早期复发的影响因素分析

Analysis of factors influencing recurrence of hepatocellular carcinoma patients after hepatectomy

目的分析肝细胞癌(HCC)患者肝切除术后早期复发的影响因素。方法回顾分析2009年1月至2012年12月复旦大学附属中山医院行肝部分切除术的178例HCC患者资料,男性151例,女性27例,年龄(58±11)岁。分析患者CT图像,评估环形强化、卫星灶、病灶内出现供血小动脉不伴有周边低密度环(TTPVI)、肿瘤边缘不规则等征象。所有患者出院后均规律随访,终点事件为术后2年内肝内复发,如未复发,则至少随访2年。结果单因素分析筛选出AFP≥200 μg/L、肿瘤最大径>5 cm、环形强化、TTPVI以及肿瘤边缘不规则为HCC患者肝切除术后复发的影响因素。将上述因素纳入多因素Cox回归分析,AFP≥200 μg/L(HR=2.144,95%CI:1.350~3.406)、环形强化(HR=2.196,95%CI:1.345~3.587)、TTPVI(HR=1.735,95%CI:1.086~2.772)及肿瘤边缘不规则(HR=2.065,95%CI:1.242~3.432)为HCC患者肝切除术后早期复发的危险因素。结论AFP≥200 μg/L及CT征象(环形强化、肿瘤边缘不规则、TTPVI)是HCC患者术后早期复发的独立危险因素。

Objective To identify the risk factors of early post-surgical recurrence of hepatocellular carcinoma (HCC) within 2 years. Methods This retrospective study included 178 consecutive patients with HCC who underwent curative resection between January 2009 to December 2012 at Zhongshan Hospital, Fudan University. There were 151 males and 27 females, with a mean age of (58±11) years. The CT features including rim enhancement, satellite nodule, two-trait predictor of venous invasion (TTPVI), and non-smooth tumor margins were reviewed. After hospital discharge, the patients were followed-up regularly for at least 2 years to detect tumor recurrence. The primary end point was recurrence of HCC. Results On univariate analyses AFP≥200 μg/L, rim enhancement, TTPVI, non-smooth tumor margins and largest diameter >5 cm were correlated with early post-surgical recurrence of HCC. On multivariate analyses, AFP≥200 μg/L (HR=2.144, 95%CI: 1.350~3.406), rim enhancement (HR=2.196, 95%CI: 1.345~3.587), TTPVI (HR=1.735, 95%CI: 1.086~2.772), and non-smooth tumor margins (HR=2.065, 95%CI: 1.242~3.432) were independent risk factors of early post-surgical recurrence of HCC. Conclusion AFP≥200 μg/L, rim enhancement, TTPVI, and non-smooth tumor margins were independent risk factors of early post-surgical recurrence of HCC.