肝细胞癌合并门静脉癌栓术后时间依赖性的预后因素分析

Time dependency of factors influencing survival of hepatocellular carcinoma patients with portal vein tumor thrombosis after surgery

目的探讨肝细胞癌伴门静脉癌栓患者手术治疗的疗效与预后因素的时间依赖性。方法分析381例肝切除术治疗肝细胞癌伴门静脉肉眼癌栓患者的临床病理因素。Kaplan-Meier法计算生存率。Cox回归分层法分析影响生存的预后相关因素。结果381例患者总的1、2、3、5及10年生存率分别为47%、23%、16%、12%及6%。2年内因肝内肿瘤复发行再切除者,再手术后重新计算的1、3及5年生存率分别为36%、14%及0;而2年后复发再切除术后的生存率则明显提高,分别为85%、53%及32%(P<0.05)。多因素分析提示门静脉灌注化疗、血清甲胎蛋白<20μg/L及手术切缘阴性是患者手术后2年内重要的有利预后因素。而丙氨酸氨基转移酶>80U/L是手术2年后惟一重要的不利预后因素。结论肝细胞癌伴门静脉肉眼癌栓患者手术2年后肝内肿瘤复发行再切除者预后明显优于2年内复发者。根据术后不同时期评价影响生存预后的因素对决定临床治疗的策略有重要价值。

Objective To investigate the surgical outcome of the hepatocellular carcinoma （HCC） patients with portal vein tumor thrombosis （PVTT） after surgery and the time-dependency of the factors influencing survival. Methods The clinicaopathological data of 382 HCC patients with macroscopic PVTY who had undergone resection of HCC were analyzed. The survival rte was calculated using Kaplan-Meier method. Stratified Cox model was used to identify the factors independently influencing the short- and long- term survival rates. Results The 1-, 2-, 3-, 5% and 10-year survival rates of the 382 patients were 47%, 23%, 16%, 12%, and 6% respectively. The 1-, 3-, and 5-year survival rates re-calculated from the time of re-resection because of recurrence within 2 years after the first operation were 36%, 14%, and 0% lrespectively. However, the 1-, 3-, and 5-year survival rates re-calculated from the time of re-resection because of recurrence 2 years after the first operation were 85% , 53% , and 32%, all significantly higher than those re-calculated from the time of re-resection within 2 years after the first operation （ all P 〈 0.05 ）. Multivariate analysis showed that portal infusion chemotherapy, serum alpha-fetoprotein 〈 20μg/L and negative surgical margin were significant favorable prognostic factors within 2 years after operation. Alanine aminotranferase 〉 80 U/L was the only significant unfavorable factor beyond 2 years after operation. Conclusion The prognosis of the patients with macroscopic PVTT who suffer from liver tumor recurrence occurring more than 2 years after the first operation is much better than those with the recurrence occurring within 2 years. Evaluation of the time-dependency of risk factors may have important clinical implication in determining the therapeutic strategy.