肝癌首发部位对患者术后复发的影响

Effect of Primary Tumor Location on Postoperative Recurrence for Patients with Hepatocellular Carcinoma

目的探讨肝癌首发部位及联合血清甲胎蛋白(AFP)表达对于预测肝癌患者术后复发及预后的意义。方法回顾性分析2005年3月—2009年10月行肝癌手术并长期随访的256例患者,运用Kaplan-Meier生存曲线分析总体生存率及术后复发率,Logrank检验P值,Cox比例风险模型进行单因素及多因素分析术后复发高危因素。结果肝癌首发部位不同,其术后总体生存率差异有统计学意义(P=0.022),且肝癌首发于全肝或肝左叶组患者较肝右叶组患者具有更高的术后复发风险(P=0.002)。分层分析发现,在AFP阴性(AFP<25 ng/ml)亚组中两者术后复发率差异有统计学意义(P<0.001)。Cox单因素及多因素分析显示远处转移(P=0.016)、血清AFP(P=0.002)及门脉癌栓(P<0.001)可以作为预测肝癌术后复发的独立危险因素,而肝癌首发部位不能作为一个独立的危险因素(P=0.088)。结论肝癌首发部位可以作为一个预测患者术后复发的危险因素。

Objective To explore the effect of primary tumor location or combined with serum AFP on the prognosis and postoperative recurrence for patients with hepatocellular carcinoma.Methods A total of 256 patients,who underwent routine surgery and with long term follow-up from March 2005 to October 2009,were retrospectively analyzed in our study.Kaplan-Meier survival curve was used to analyze overall survival（OS） and time to recurrence（TTR） and Logrank test was used to calculate P values.Univariate and multivariate analysis of clinicopathological parameters in hepatocellular carcinoma（HCC） patients with postoperative recurrence were carried out by Cox-regression analysis.Results There was different in overall survival of HCC patients based on their primary tumor location（P=0.022）.Furthermore,the group with left or double hepatic lobe tumor demonstrated a higher recurrence risk than that of patients in the group with right hepatic lobe tumor（P=0.002）.In a stratified analysis,there was a significant difference in the postoperative recurrence rate under the subset of negative serum AFP（AFP25 ng/ml）（P0.001）,whereas no difference in the subset of positive serum AFP（AFP≥25 ng/ml）（P=0.258）.Univariate and multivariate analysis showed that metastasis,serum AFP and Portal vein tumor thrombus（PVTT） were 3 dependent recurrent risk factors,whereas primary tumor location was not.Conclusion Primary tumor location can be served as an important recurrent risk factor in HCC patients after hepatectomy.