术前血小板计数在评价肝细胞癌切除术后患者生存预后中的价值

Preoperative platelet count in predicting prognosis of patients with hepatocellular carcinoma after hepatectomy

目的探讨肝细胞癌(肝癌)患者术前Plt在评价术后生存预后中的价值。方法回顾性研究1987年1月至1994年12月在中山大学肿瘤防治中心肝胆肿瘤外科行肝癌肝切除的399例患者临床资料。所有患者均签署知情同意书,符合医学伦理学规定。其中男356例,女43例;年龄21~78岁,中位年龄48岁。观察术前Plt与患者性别、年龄、GGT、HBsAg、AFP、肝硬化、肿瘤包膜、肿瘤直径、肿瘤数目、肿瘤血管侵犯、肿瘤组织学分化程度等临床病理学参数的关系。根据术前Plt将患者分为G1组(<100×109/L,41例)、G2组(100×109/L^300×109/L,321例)、G3组(>300×109/L,37例),对3组患者进行生存分析。术前Plt与临床病理学参数的关系比较采用t检验,生存分析采用Kaplan-Meier法和Log-rank检验,生存预后分析采用Cox比例风险回归模型分析。结果术前Plt与HBsAg、AFP、肿瘤直径有关(t=2.069,2.222,-3.911;P<0.05)。G1组患者5、10、15年累积生存率分别为41.2%、25.2%、11.8%,G2组分别为33.7%、23.0%、18.1%,G3组分别为11.4%、8.6%、5.7%。G3组患者生存率明显低于G1组和G2组(χ2=5.706,11.361;P<0.05)。术前Plt增多为患者术后生存预后的独立危险因素,G3组患者生存预后较G1组和G2组差(HR=1.761,1.845;P<0.05)。结论肝癌患者术前Plt增多为肝癌肝切除术后生存预后的独立危险因素,术前Plt增多的患者预后差。

Objective To investigate the value of preoperative platelet count （Pit） in predicting prognosis of patients with hepatocellular carcinoma （HCC） after hepatectomy. Methods Clinical data of 399 patients who underwent hepatic resection for HCC in Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center from January 1987 to December 1994 were analyzed retrospectively. The informed consents of all patients were obtained and the ethics committee approval was received. Of the 399 patients, 356 cases were male, and 43 cases were female with age ranging from 21 to 78 years old and a median age of 48 years old. The relations between preoperative Pit and patients＇ gender, age, gamma-glutamyl transpeptidase（GGT）, hepatitis B surface antigen （HBsAg）, alpha fetal protein （AFP）, cirrhosis, tumor encapsulation, tumor diameter, tumor number, vascular invasion and histological differentiation were observed. Patients were divided into 3 groups according to the level of preoperative Plt： group 1 （〈100×10^9/L, n=41）, group 2 （100×10^9/L-300×10^9/L, n=321）, group 3 （〉300×10^9/L, n=37）. Survival analysis of patients in 3 groups was conducted. The relations between preoperative Plt and clinicopathological parameters were compared using t test. Survival analysis was conducted using Kaplan-Meier method and Log-rank test. Survival prognosis was analyzed using Cox＇s proportional hazard model. Results Preoperative Plt was associated with HBsAg, AFP, and tumor diameter （t=2.069, 2.222, -3.911; P〈0.05）. The 5-, 10-, 15-year cumulative survival rates were 41.2%, 25.2%, 11.8% in group 1, 33.7%, 23.0%, 18.1% in group 2, and 11.4%, 8.6%, 5.7% in group 3 respectively. The survival rate in group 3 was significantly lower than those in group 1 and group 2 （x2=5.706, 11.361; P〈0.05）. Increasing preoperative Plt was an independent risk factor for postoperative prognosis. The prognosis in group 3 was poorer than those in group 1 and group 2 （HR=1.761, 1.845; P〈0.05）. Conclusions Increasing preoperative Pit is an independent risk factor for postoperative prognosis of patients with HCC after hepatectomy. Patients with increasing preoperative Plt have poor prognosis.