摘要
目的了解原发性肝细胞癌(HCC)自发性破裂(SR)的预后影响因素。方法2005年1月1日至2011年4月1日间,我院收治HCC-SR44例,其中19例行根治性肝切除术,同期收治根治性肝切除术治疗非SR的HCC(non-HCC-SR)137例,对两组患者复发率、无瘤生存率、总体生存率和生存影响因素等作比较。Kaplan—Meier法计算总体生存时间,作Log—rank检验。COX比例风险模型行HCC—SR生存多因素分析。结果(I)术后1、2、3、5年累积复发率:HCC—SR组分别为78.9%(15/19)、89.5%(17/19)、94.7%(18/19)和94.7%(18/19);non—HCC—SR组分别为43.1%(59/137)、54.0%(74/137)、59.1%(81/137)和66.4%(91/137),P值分别为0.006、0.003、0.002和0.014,差异均有统计学意义;(2)术后1、2、3、5年无瘤生存率:HCC-SIR组分别为10.5%(2/19)、5.3%(1/19)、5.3%(1/19)和5.3%(1/19)}non-HCC-sR组分别为40.1%(55/137)、21.2%(29/137)、12.4%(17/137)和4.4%(6/137),两组比较,仅1年无瘤生存率差异有统计学意义泸=0.011);(3)术后1、2、3、5年总体生存率:HCC-SR组分别为42.1%(8/19)、10.5%(2/19)、5.3%(1/19)和5.3%(1/19)lnon—HCC-SR组分别为59.1%(81/137)、32.8%(45/137)、19.0%(26/137)和6.6%(9/137),差异均无统计学意义。多因素分析显示肝硬化程度、甲胎蛋白值、治疗方式和HCC—SR分型是HCC—SR的生存影响因素。结论HCC—SR行根治洼肝切除术后复发率明显高于non-HCC—SR,但总体预后类似于non-HCC—SR。肝硬化程度,甲胎蛋白值,治疗方式和HCC—SR分型是HCC-SR的生存影响因素。
Objective To explore the prognostic factors influencing overall survival (OS) in patients with spontaneous rupture of hepatocellular carcinoma (HCC-SR). Methods The medical records of 44 patients with HCC-SR treated in our department from January 1, 2005 to April 1 2011 were retrospectively reviewed. The clinical and prognostic data of 19 HCC-SR patients who received curative hepatectomy were compared with data of 137 HCC patients with no SR who were managed by curative hepatectomy during the same period. Type of HCC-SR was defined according to previously established criteria. The clinicopathological data were evaluated for possible associations with OS of HCC-SR by univariate analysis with the Kaplan-Meier method followed by multivariate analysis with the Cox proportional hazard model. Results While some clinical features differed between the HCC-SR patients and non-HCC-SR patients, the postoperative prognosis was comparable between the two groups: (1) The 1-, 2-, 3- and 5-year postoperative cumulative recurrence rates were 78.9% (15/19), 89.5% (17/19), 94.7% (18/19) and 94.7% (18/19) in the HCC- SR group but 43.1% (59/137), 54.0% (74/137), 59.1% (81/137) and 66.4% (91/137) in the non-HCC-SR group respectively, and the differences reached statistical significance (P = 0.006, 0.003, 0.002, and 0.014); (2) The 1-, 2-, 3- and 5-year postoperative disease-free survival rates were 10.5% (2/19), 5.3% (1/19), 5.3% (1/19) and 5.3% (1/19) in the HCC-SR group but 40.1% (55/137), 21.2% (29/137), 12.4% (17/137) and 4.4% (6/137) in the non-HCC-SR group respectively, and only the 1-year disease-flee survival rate was significantly different (P = 0.032); (3) The I-, 2-, 3- and 5-year postoperative OS rates were 42.1% (8/19), 10.5% (2/19), 5.3% (1/19) and 5.3% (1/19) in the HCC-SR group but 59.1% (81/137), 32.8% (45/137), 19.0% (26/137) and 6.6% (9/137) in the non-HCC-SR group, and none of the differences reached statistical significance (P = 1.972, 0.061, 0.200, 1.000). Multivariate analysis identified that severity of concomitant liver cirrhosis, levels of alpha fetoprotein (AFP), choice of treatment modality, and type of HCC-SR acted as factors influencing OS. Conclusion Patients with HCC-SR receiving curative hepatectomy have higher postoperative recurrence rates than their non-HCC- SR counterparts, but the two groups have similar postoperative OS rates. OS is influenced by severity of concomitant liver cirrhosis, level of AFP, choice of treatment modality, and type of HCC-SR.
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2012年第11期838-842,共5页
Chinese Journal of Hepatology
基金
四川省2011年度教育厅基金(11ZB185)
关键词
癌
肝细胞
破裂
治疗
预后
肝切除术
Carcinoma,.hepatocellular
Rupture
Therapy
Prognosis
Hepatectomy