乙型与丙型肝炎病毒感染对小肝癌患者预后的影响

Comparison of prognosis of small hepatocellular carcinoma patients with hepatitis B virus infection versus hepatitis Cvirusinfection

目的探讨HBV、HCV感染对小肝癌的外科治疗策略及其预后的影响。方法回顾性分析1997年1月-2003年12月天津医科大学附属肿瘤医院413例行手术根治切除治疗的小肝癌（≤3cm）患者的临床资料，将其分为4组：HCV感染组75例、HBV感染组251例、HCV、HBV混合感染组33例和无HCV、HBV感染组54例，对可能影响预后的因素采用KaplanMeier生存分析、log-rank时序检验。结果413例患者术后1、3、5年无瘤生存率分别为83％、66％和58％，术后共有168（40．8％）例患者出现肝内复发，5年复发率HCV感染组最高（64．2％），其次为HBV＋HCV感染组（48．4％），HBV感染组（37．8％）及无感染组（32．3％）。肝内复发肿瘤为多发者在HCV感染组发生率最高（占肝内复发肿瘤的66．0％），其次为HBV＋HCV感染组（28．6％），HBV感染组（23．3％）及无感染组（17．6％）。413例小肝癌患者术后1、3、5年总生存率分别为89％、70％和61％，HCV感染组预后最差。和其他组相比，HCV感染组肝硬化程度严重，肿瘤细胞分化低，更易发生血管侵犯。在随访过程中，HCV感染组肝内复发率高，且复发类型常为多结节型。结论HCV感染相关肝癌的临床肝硬化症状更重，而且术后复发率较高，预后更差。

Objective To compare the prognosis of small hepatocellular carcinoma patients with hepatitis B virus infection versus hepatitis C virus infection. Methods 413 patients receiving curative resections at Tianjin Cancer Hospital for small HCC （≤ 3 cm） from January 1997 to December 2003 were divided into four groups： HCV only （n = 75）, HBV only （n = 251）, HBV and HCV （n = 33）, and neither HBV nor HCV （NBNC, n = 54）. The preoperative status and postoperative recurrence were recorded. Survival analysis were used to assess the impact of HBVPHCV status on HCC recurrence. Results Patients with HCV were associated with older age, lower mean preoperative platelet counts and albumin levels, higher mean prothrombin time, alanine aminotransferase and total bilirubin levels. Tumors in patients with HCV are mul- tinodular and less differentiated, and were associated with a higher incidence of vascular invasion and cirrhosis. During the follow-up, the HCV group showed a higher incidence of intrahepatic recurrence and multiple recurrent lesions than the other patients. Conclusions HCC patients with HCV infection tended to be older, and were characterized by more severe cirrhosis and higher incidence of tumor multinodular. The statistically significant determinants of reoccurrence in patients with small HCC were HCV infection, presence of vasculax invasion and multiple tumors.