影响肝细胞癌术后早期复发的相关因素Cox模型分析

Analysis of factors influencing early recurrence of hepatocellular carcinoma after curative hepatectomy by Cox proportional hazard regression model

目的探讨影响肝细胞癌术后早期复发的相关因素,为术后综合治疗及判断预后提供依据。方法回顾性分析195例实施肝癌根治性切除术,且术后病理诊断证实为肝细胞癌的病例的临床病理资料,对18项潜在的可能影响肝细胞癌术后早期复发的临床病理因素进行统计学分析。结果全组术后早期复发82例(42.05%)。早期复发组的1、2、3年的累积生存率分别为55.9%、22.5%和13.3%,对照组相应的累积生存率分别为100%、95.3%和77.7%,两组生存曲线的差异有统计学意义(x^2=134.825,P<0.001)。Cox模型多因素分析结果显示:术前白蛋白浓度、术前碱性磷酸酶浓度、肿瘤病灶数目和手术中输血量是影响肝细胞癌术后早期复发的有统计学意义的因素。结论根治性切除术后容易复发是肝细胞癌的生物学特性之一,肝细胞癌术后早期复发取决于多种因素的共同作用,术前碱性磷酸酶浓度、肿瘤病灶数目、手术中输血量是影响肝细胞癌术后早期复发的独立危险因素。

Objective To explore the risk factors influencing early recurrence of hepatoeellular eareinorna （HCC） after curative hepateetomy and to provide the evidence for postoperative comprehensive therapy and the judgment of prognosis. Methods The clinical and pathologic data of 195 patients receiving curative hepateetomy of HCC that was confirmed by pathologic diagnose were retrospectively analyzed. Eighteen clinical and pathologic factors potentially contributing to early recurrence of HCC after curative hepateetomy were evaluated by statistical analysis. Results Eighty - two eases of patients （42.05 % ） underwent early reeurrenee within 1 year after hepateetomy. The cumulative survival rate of 1,2 and 3 years in the early recurrence group was 55.9 %, 22.5 % and 13.3%, respectively. The cumulative survival rate of 1,2 and 3 years in the control group was 100% ,95.3% and 77.7 %, respectively. The difference of survival curve between the early recurrence group and the control group had statistically significance（ χ^2 = 134. 825, P 〈 0. 001）. The Cox model multivariate analysis indicated that preoperative ALB level, preoperative ALP level, number of tumor nodules and blood transfusion volume during operation were the factors effeeting early recurrence of HCC after eurative hepateetomy whieh had statistically significance. Conclusion Easily reeurrenee after curative hepatectomy is one of important biological characteristics of HCC. The independent risk factors effeeting early recurrence of HCC after curative hepateetomy include preoperative ALP level, number of tumor nodules and blood transfusion volume during operation.