青年原发性肝癌的临床病理特征及肝切除术后的生存分析

Analysis of clinicopathological characteristics and prognostic survival factors of primary hepatic carcinoma after hepatic resection in young patients

目的总结青年原发性肝癌患者的临床病理特征及手术切除的效果,探讨影响肝切除术后生存的因素。方法回顾性分析西安交通大学医学院第一附属医院2008年1月至2012年9月行肝切除术的79例年龄≤40岁的青年原发性肝癌患者的临床、实验室检查、病理学特征,并与同期收治的67例年龄≥65岁的老年原发性肝癌患者作为对照,分析青年原发性肝癌的临床病理特点,并以死亡作为终点事件,对手术切除术后的生存率及预后相关危险因素进行分析。结果青年肝癌患者的乙肝表面抗原阳性率、甲胎蛋白值明显高于老年组(P<0.05),丙肝抗体阳性率明显低于老年组(P<0.05)。而两组患者的性别构成、临床症状、术前肝功能Child-Pugh分级、吲哚氰绿15min滞留率、肝切除范围、手术时间、术中失血量、术后住院天数、肝硬化、肿瘤个数、大小、门静脉癌栓、肿瘤分化程度、术后生存率等方面无统计学差异(P>0.05)。经COX比例风险模型分析后发现,术前白蛋白<35g/L和最大肿瘤直径≥5cm是影响青年原发性肝癌术后生存的危险因素。结论手术切除治疗青年、老年肝癌是安全的、可行的。术前白蛋白<35g/L和最大肿瘤直径≥5cm是青年肝癌患者生存的独立影响因素。

Objective To analyze the clinicopathological characteristics and the prognostic survival factors of young patients who have undergone hepatectomy for primary hepatic carcinoma. Methods Clinicopathological da- ta and treatment outcomes in 79 young （≤40 years old） and 67 elderly （≥65 years old） patients who underwent hep- atectomy for primary hepatic carcinoma between 2008 and 2012 were retrospectively collected and compared using various parameters. Then the survival rate and prognostic factors of the younger patients were analyzed using Kap- lan-Meier and COX multivariate proportional hazards model. Results The positive rate of HBs-antigen and alpha- fetoprotein level were significantly higher in the younger patients than in the elderly patients （P〈0.05）. However, the positive rate of Anti-HCV-Ab was markedly lower in the younger patients （P〈0.05）. The two groups did not significantly differ in gender, clinical symptoms, intraoperative parameters or pathological features （P〉0.05）. The overall survival rate was similar between the two groups. COX multivariate proportional hazards model analysis showed that the independent prognostic factors of overall survival were pre-operative albumin level 〈 35 g/L and maximum tumor diameter ≥5 cm. Conclusion Hepatectomy is a safe and feasible treatment for young and elderly patients with primary hepatic carcinoma. The independent prognostic factors of survival for young patients are pre- operative albumin level 〈35 g/L and the maximum tumor diameter ≥5 cm.