透明细胞型肝癌术后早期及晚期复发的多因素分析

Multivariate analysis of risk factors of early and late recurrences after resection for primary clear cell carcinoma of liver

目的探讨影响透明细胞型肝癌（primary clear cell carcinoma of the liver，PCCCL）术后早期及晚期复发的相关危险因素。方法对1996年1月至2006年3月手术治疗的214例PCCCL患者临床病理及随访资料进行回顾性分析。术后≤1年复发者定义为早期复发，术后1年以上复发者定义为晚期复发。结果99例患者术后复发，其中早期复发者28例，晚期复发者71例。复发患者的3年及5年总生存率分别为68．7％和46．2％，显著低于未复发患者（72．2％和64．3％，P=0．003）。晚期复发患者1年、3年和5年的总生存率分别为100％、80．3％和54．6％，显著优于早期复发患者（85．7％、39．3％和25．0％，P=0．001）。多因素分析显示丙氨酸转氨酶（aminoleucinetransferase，ALT）水平和血管侵犯是PCCCL术后早期复发的独立危险因素，而年龄则是PCCCL患者术后晚期复发的惟一独立危险因素。结论复发时间是影响PCCCL．术后复发患者预后的主要因素。明确PCCCL早期及晚期复发的不同危险因素，有助于指导患者术后随访并及时发现复发，提高生存率。

Objective To investigate the risk factors influencing early and late recurrences after resection of primary clear cell carcinoma of the liver （PCCCL）. Methods 214 PCCCL patients treated by curative resection from January 1996 to March 2006 were retrospectively analyzed. Recurrences were classified into early （41 year） and late （〉1 year） recurrences. Results 99 patients developed recurrences, with early recurrence in 28 patients and late recurrence in 71 patients. The 3-and 5-year overall survival （OS） rates for recurrent PCCCL were significantly worse than those with no recur- rence （68.7% and 46.2% vs 72.2% and 64.3%, P=0. 003）. The 1-, 3- and 5-year OS rates for late recurrence were 100%, 80.3% and 54.6%, which were significantly better than those with early re currence （85.7%, 39.3% and 25.0% ,P 0. 001）. On multivariate analysis, aminoleucine transferase （ALT） level and vascular invasion were independent risk factors for early recurrence, while age was the only significant risk factor for late recurrence. Conclusions The time to recurrence was the main de- terminant for prognosis of recurrent PCCCL. Clarifying the different risk factors for early and late recur- rences will help postoperative follow-up, early detection of recurrence, and hopefully will improve survival.