原发性肝细胞癌自发性破裂的预后分析

Survival analysis of patients with spontaneous rupture of hepatocellular carcinoma

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.