巨大肝癌外科治疗的预后影响因素

Prognostic factors for patients who underwent surgical treatment for huge liver cancer

目的分析外科治疗巨大肝癌的预后相关因素，提高其综合治疗水平。方法回顾性分析51例经外科治疗的巨大肝癌患者的临床资料。应用Kapla—Meier方法计算生存时间，Cox回归法对15个可能与预后相关的临床病理因素进行统计学分析。结果50例患者获得随访。术后1、3、5年生存率分别为75．8％、37．9％和21．1％。单因素分析显示术前AFP大于400μg/L、肿瘤大于12cm、肿瘤边界是否清楚、有无血管侵犯、TNM分期与巨大肝癌的预后有关；Cox多因素回归分析结果显示，有无血管侵犯、肿瘤边界是否清楚、肿瘤大于12cm是影响巨大肝癌预后的独立因素。单因素分析显示肿瘤边界是否清楚、有无血管侵犯、TNM分期是影响患者复发的重要因素；Cox多因素分析显示血管侵犯是影响患者复发的独立因素。结论外科治疗巨大肝癌相对安全可靠，可改善患者预后。对高危因素患者需要依靠综合治疗以延长生存期。

Objective To analyze the prognostic factors for patients who underwent surgical resection for huge liver cancer so as to improve the medical results of comprehensive therapy. Methods We retrospectively anlaysed the data of 51 patients who underwent surgical resection for huge liver cancer. Fifteen clinicopathologic factors possibly influencing survival were selected, and multivariate analysis of these parameters was performed using the Cox proportional hazards model. Survival analysis was done using the Kaplan-Meier method. Results The overall 1-, 3-, 5-year survival rates of 50 patients were 75.8%, 37.9% and 21.1%, respectively. Univariate analysis showed that AFP over 400 μg/L, tumor diameter over 12 cm, tumor boundary, vascular invasion and TNM staging significantly affected postoperative survival. Cox multivariate analysis indicated that tumor diameter of ≥ 12 cm, tumor boundary and vascular invasion were independent prognostic factors. Univariate analysis showed that tumor boundary, vascular invasion and TNM staging were the independent factors affecting recurrence, Cox multivariate analysis showed that vascular invasion was an independent factor influencing recurrence of tumor. Conclusions Surgical resection for patients with huge liver cancer could be safely performed with reasonable long-term survival. For patients having tumors with poor prognostic factors, there is a need for effective adjuvant therapy.