合并肝硬化的肝细胞癌病人预后相关因素分析

Analysis the related factors affecting prognosis of hepatocellular carcinoma patients with liver cirrhosis

目的:探讨合并肝硬化的肝细胞癌病人肝切除术后预后的影响因素。方法:收集我院1996年至2001年共415例合并肝硬化肝细胞癌病人的临床病例资料,随访终止于2009年9月1日,死亡为终点事件。分析影响合并肝硬化肝细胞癌病人术后累积复发率和总体生存率的危险因素。结果:术中大出血组(术中出血量>600 mL)和非大出血(对照)组(≤600 mL)的1、3、5、10年累积复发率分别为49.9%、61.4%、70.6%、81.8%和32.2%、52.3%、60.8%、72.0%(P=0.040);总体生存率分别为75.0%、33.3%、25.1%、9.8%和83.5%、58.1%、48.1%、36.0%。大出血组与对照组具有显著统计学差异(P<0.001)。通过单因素及多因素分析得出,肿瘤多发(HR=1.86,P≤0.001)、肿瘤直径>5 cm(HR=1.73,P<0.001)、乙肝表面抗原阳性(HR=1.64,P=0.007)和微血管侵犯(HR=1.40,P=0.023)是影响肿瘤复发的危险因素。影响肝切除术后总体生存的危险因素包括:肿瘤多发(HR=1.87,P≤0.001)、肿瘤直径>5 cm(HR=1.82,P<0.001)、肿瘤无包膜(HR=1.49,P=0.012)、术中大出血(HR=2.15,P=0.024)和微血管侵犯(HR=1.45,P=0.023)。结论:乙肝表面抗原阳性、肿瘤多发、肿瘤直径>5 cm、微血管侵犯、肿瘤无包膜和术中出血量>600 mL能显著影响合并肝硬化肝细胞癌病人的预后。其中,术中大出血对远期生存的影响最为显著。

Objective To investigate the factors affecting the prognosis after hepatic resection for hepatocellular carcinoma （HCC） in cirrhotic liver. Methods Four hundred fifteen cases underwent hepatectomy for HCC with cirrhosis in Eastern Hepatobiliary Surgery Hospital from 1996 to 2001 were enrolled in this study. Follow-up was ended on September 1, 2009 or when the patient died. Prognostic factors affecting survival and recurrence after hepatic resection for HCC in cirrhotic liver were analyzed. Results The 1-, 3-, 5- and 10-year cumulative recurrence rates in intraoperative massive hemorrhage group （blood loss〉600 mL） and control group （blood loss~〈600 mL） were 49.9%, 61.4%, 70.6%, 81.8% and 32.2%, 52.3%, 60.8%, 72.0% （P-d3.040）, respectively. The overall survival rates of 1-,3-,5-and 10-year were 75.0%, 33.3%, 25.1%, 9.8% and 83.5%, 58.1%, 48.1%, 36.0%. The difference of the recurrence rates and the survival rates between two groups was all statistically significant （P〈O.O01）. It was shown by univariate and multivariate analysis that multiple tumors （HR=l.86,P〈O.O01）, tumor diameter 〉5 cm（HR=l.73,P〈 0.001）, hepatitis B surface antigen-positive （HR=l.64,P---O.O07） and microvaseular invasion （HR=l.40,P=0.023） were risk factors associated with the cumulative recurrence rate. Multiple tumors （HR=l.87,P〈0.001）, tumor diameter 〉5 cm （HR=l.82,P〈O.O01）, without tumor capsule（HR=l.49,P=0.0 12）, blood loss 〉600 mL（HR=2.15,/x--0.024） and microvascular invasion（HR=l.45 ,P--0.023） were associated with the overall survival rate. Conclusions Hepatitis B surface antigen-positive, multiple tumors, tumor diameter〉5 cm, microvascular invasion,without tumor capsule, blood loss〉600 mL and microvascular invasion could affect the prognosis of the patients with hepatocellular carcinoma in cirrhotic liver. Blood loss 〉600 mL intraoperative is the most significant clinicopathological variable of them.