TNM分期对评价肝细胞癌切除术预后的价值

Significance of TNM clasification in prognostic evaluation of hepatocelluar carcinoma following surgical resection

目的 研究ＴＮＭ 分期与原发性肝细胞癌术后无瘤生存的相关性，探讨其预测手术远期疗效的价值。方法 对１ ７２５ 例行根治和相对根治性切除的肝癌患者进行回顾性随访，将随访资料完整的１ ４５７例临床和病理因素应用Ｃｏｘ 模型进行单因素和多因素分析，无瘤生存期（ 率） 采用ＫａｐｌａｎＭｅｉｅｒ 法计算。结果 Ｃｏｘ 模型单因素分析结果显示，有１３ 个相关临床因素影响肝癌术后无瘤生存时间；多因素分析显示，其中术前影像学检查瘤灶数目、瘤灶的大小、有无瘤旁子灶和肝内血管（ 包括癌巢内外微小血管） 是否受到侵犯与无瘤生存期有着密切关系。ＴＮＭⅠ期和Ⅱ期患者的术后无瘤生存率明显高于Ⅲ期和Ⅳ期，但是Ⅰ期与Ⅱ期之间差异无显著性。结论 ＴＮＭ 分类基本上反映了肝癌切除术的预后，与现今常用的临床３ 期分类结合应用，能较客观地预见术后远期疗效，并有助于临床医生治疗方法的选择。

Objective To investigate correlation between TNM classification of HCC and local regional cancer free survival time after hepatectomy. Methods A retrospective survey was carried out in 1 725 cases with hepatocellular carcinoma (HCC) receiving radical or relatively radical operation from Jan. 1, 1990 through Dec. 31, 1995. The follow up rate was 84.46%. The factors under consideration were analysed using Cox proportional hazards survival model and Kaplan Meier estimation. Results Univariate analysis showed that 13 clinical and pathologic factors, including clinical stage, age, portalvein tumor thrombus, tumor number found before and/or during operation, radical or relatively radical resection, size of tumor, growing pattern, encapsulation of tumor, daughter nodules (including microscopic nodules), vascular invasion, TNM stage, AFP level after hepatectomy and so on, might all influence local regional cancer free survival time. Multivariate analysis revealed four significant prognostic factors: tumor number found before operation, tumor size, daughter nodules and vascular invasion. These four factors were encompassed in TNM staging. By Kaplan Meier estimation, tumor free survival rate at 0.5, 1, 3, and 5 years was as follows: at stage Ⅰ 90.7%, 79.1%, 45 8%, 24 6%;at stage Ⅱ 86 6%, 75 5%, 51 8%, 38 4%; at stage Ⅲ 62 6%, 41 5%, 20 6%, 15 9%; at stage Ⅳa 33 0%, 18 6%, 8 0%, 5 3%; at stage Ⅳ b 42 3%, 35 3% The mean tumor free survival time of stage Ⅰ to Ⅳ b was 34.36, 38.25, 10.01, 4.06 and 4.26 months, respectively. There was no significant difference in tumor free survival rate btween stage Ⅰ and Ⅱ. Conclusion TNM stage is one of the most significant prognostic factors determining tumor free survival after HCC resection.