符合米兰标准的早期肝癌患者肝切除术后生存分析

A survival analysis of patients with early-stage hepatocellular carcinoma fulfilling Milan criteria and undergoing hepatectomy

目的 总结符合米兰标准的肝癌患者肝切除术经验,探讨影响术后生存和复发生存的临床及病理因素.方法 回顾性分析北京协和医院2003年4月至2009年6月期间收治的104例符合米兰标准并经手术切除的早期肝癌患者的临床及病理资料.结果 中位随访时间24个月,54例复发,1、3、5年累积无复发生存率分别为63.0%,32.6%和22.4%,复发组与无复发组之间临床病理参数差异无统计学意义,单因素及多因素分析均未提示与复发显著相关的因素（P＞0.05）.1、3、5年累积生存率分别为88.8%,68.1%和68.1%,单因素分析显示输血（P=0.000）、累及肝被膜（P=0.000）、术后介入治疗（P=0.049）与生存显著相关 多因素分析则显示输血（P=0.001）和累及肝被膜（P=0.000）是影响生存的独立预后因素.结论 对于符合米兰标准且肝功能处于代偿期的早期肝癌患者,在治疗策略上可以将肝切除作为首选治疗方案.

Objective To summarize the experience of hepatectomy in patients with hepatocellular carcinoma fulfilling the Milan criteria and analyze the clinicopathological factors for patient survival and tumor recurrence. Methods The clinicopathological data of 104 patients with early-stage hepatocellular carcinoma fulfilling the Milan criteria and underwent hepatectomy at Peking Union Medical College Hospital between April 2003 and June 2009 were retrospectively analyzed. Results The median follow-up was 24 months. There were 54 recurrent cases. The 1-, 3- and 5-year cumulative disease-free survival rate were 63.0%, 32. 6% and 22. 4% respectively. Neither univariate analysis nor multivariate analysis indicated any factor significantly correlated with recurrence （ P 〉0. 05）. The cumulative overall survival rate at 1,3 and 5 years were 88. 8%, 68. 1% and 68. 1% respectively. Univariate analysis revealed that blood transfusion （P = 0. 000）, involvement of hepatic capsule （ P = 0. 000 ） and postoperative transarterial chemotherapy （P =0. 049） were significantly correlated with survival And multivariate analysis indicated that blood transfusion （P = 0. 001 ） and involvement of hepatic capsule （P = 0. 000） were independent prognostic factors for survival. Conclusion For the patients with early-stage hepatocellular carcinoma and compensated liver function fulfilling the Milan criteria, hepatectomy serves as the preferred treatment strategy.