原发性肝癌患者手术切除术后早期复发影响因素分析

Analysis of factors for early recurrence of patients with hepatocellular carcinoma after resection

目的:探讨原发性肝癌(HCC)患者手术切除后早期复发的影响因素。方法:回顾性分析郑州大学第一附属医院2014年1月—2016年1月期间450例经手术切除的HCC患者的临床与随访资料,通过统计学方法分析HCC术后早期复发的影响因素。结果:450例患者中,2年内复发182例(40.4%)。单因素分析结果显示,HCC术后复发与门脉癌栓、术前血清AFP水平、肿瘤数目、最大直径、肿瘤分化程度有关(均P<0.05);Cox比例风险回归分析显示,肿瘤数目(RR=2.148,95%CI=1.175～3.924,P=0.013),肿瘤最大直径(RR=1.591,95%CI=1.006～2.518,P=0.047),门脉有无癌栓(RR=1.835,95%CI=1.242～2.709,P=0.001),血清AFP水平(RR=1.722,95%CI=1.141～2.601,P=0.010),肿瘤分化程度(RR=1.463,95%CI=1.071～1.998,P=0.017)均是HCC术后复发的独立因素。通过以上因素建立函数模型对预测HCC术后早期复发的风险程度有一定价值(似然比检验:χ~2=45.727,P<0.001)。结论:HCC患者手术切除术后早期复发的影响因素较多,其中门脉癌栓、肿瘤数目、最大直径、肿瘤分化程度、血清AFP水平可能是造成复发的独立危险因素,术前综合评估这些因素对预防术后复发有一定的指导意义。

Objective: To investigate the factors for early recurrence of patients with hepatocellular carcinoma(HCC) after surgical resection.Methods: The clinical and follow-up data of 450 HCC patients undergoing surgical resection from January 2014 to January 2016 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. The factors for early postoperative recurrence of HCC were determined by statistical analysis. Results: Of the 450 patients, recurrence within 2 years after surgery occurred in 182 cases(40.4%). Results of univariate analysis showed that portal vein tumor thrombus and preoperative serum AFP level as well as the number, maximum diameter and differentiation of the tumor were significantly associated with the postoperative recurrence of HCC(all P<0.05). Results of Cox proportional risk regression analysis showed that lesion number(RR=2.148, 95% CI=1.175–3.924, P=0.013), maximum diameter of tumor(RR=1.591, 95% CI=1.006–2.518, P=0.047), presence and absence of the portal vein tumor thrombus(RR=1.835, 95% CI=1.242–2.709, P=0.001), serum AFP level(RR=1.722, 95% CI=1.141–2.601, P=0.010), and degree of differentiation(RR=1.463, 95% CI=1.071–1.998, P=0.017) were all independent factors for postoperative recurrence of HCC. The functional prediction equation established by incorporating these factors had certain value in estimating the early postoperative recurrence of HCC(likelihood-ratio test: χ^2=45.727, P<0.001).Conclusion: There are multiple factors that affect the early recurrence of HCC patients after surgical resection, among which portal vein tumor thrombus, lesion number, and maximum diameter and differentiation degree of the tumor and serum AFP level may be independent risk factors for recurrence. Integrated evaluation of these factors before operation has certain directive significance in preventing postoperative recurrence.