预测肝癌微血管侵犯及早期复发的临床研究

Predictive factors of microvascular invasion and early recurrence in patients with hepatocellular carcinoma

目的探讨预测肝癌患者微血管侵犯的因素,并探讨影响肝癌患者术后早期复发的因素。方法回顾性分析147例肝癌根治性切除患者的临床病理特征。其中,有微血管侵犯的患者93例(甲组),无微血管侵犯的患者54例(乙组)。单因素及多因素分析预测微血管侵犯及早期复发的因素,随访患者术后无瘤生存期,分析预测术后早期复发的因素,ROC曲线评价预测微血管侵犯和预测术后早期复发的因素。结果 Logistic回归分析提示肿瘤直径是预测肝癌微血管侵犯的独立因素;ROC曲线下面积为0.823,肿瘤直径越大越容易出现微血管侵犯(P<0.001)。Cox回归分析提示肿瘤大体分型、微血管侵犯是预测肝癌患者术后早期复发(<2年)的独立因素,ROC曲线下面积分别为0.695,0.727。肿瘤大体分型级别越高或存在微血管侵犯的患者,手术后易早期复发(P<0.001)。结论术前明确肿瘤分型,预测肝癌微血管侵犯可以推测患者预后,并对术后治疗有一定的指导作用。

Objective To identify preoperative predictors of microvascular invasion and early recurrence in patients with hepatocellular carcinoma(HCC).Methods 147 patients underwent curative hepatic resection for HCC were retrospectively analyzed.93 had HCC with microvascular invasion,54 had HCC without microvascular invasion.Univariate and multivariate analysis were used to identify preoperative predictors of microvascular invasion and early recurrence.ROC curve was used to evaluate the predictor of microvascular invasion and early recurrence.Results Logistic regression indicated that tumor size was significant predictive factors in identifying microvascular invasion of HCC.Area under the curve was 0.823.The large size of tumor can predict the more occurrence of microvascular invasion(P<0.001).The type of tumor and microvascular invasion were independent predictive factors in identifying early recurrence(less than 2 years)in patients with HCC.Area under the curve was 0.659 and 0.727 respectively.The high grade type of tumor and presence of microvascular invasion can predict early recurrence of tumor.Conclusions It is useful to predict the type of tumor and microvascular invasion preoperatively for predicting the prognosis of patients with HCC.It can partly indicate the treatment postoperatively.