原发性肝细胞癌R_0切除术后肝外转移患者生存分析

Survival analysis on patients with extrahepatic metastasis after R_0 resection for primary hepatocellular carcinoma

目的分析原发性肝细胞癌(hepatocellular carcinoma,HCC)患者R0切除术后肝外转移的生存时间和影响因素。方法回顾性分析2001-01-2010-12青岛大学附属医院收治的597例行R0切除术的原发性HCC患者临床资料和随访结果。Logistic回归分析术后肝外转移复发较单纯肝内复发的独立危险因素;Kaplan-Meier(Log-rank检验)分析不同部位肝外转移患者的预后。结果肝内复发组中位生存时间18.0个月,显著长于肝外转移复发组的8.0个月,χ2=25.2,P<0.001。经Logistic回归分析,年龄>60岁(OR=2.555,P=0.003)、肿瘤直径>5cm(OR=2.094,P=0.027)、肿瘤亚临床破裂型(OR=6.407,P=0.010)和血管癌栓(OR=5.267,P=0.003)为发生肝外转移的独立危险因素。单因素分析显示,与肝内复发组比较,肝外转移组中肿瘤亚临床破裂型(χ2=8.261,P=0.004)、HBsAg或Anti-HCV阳性(χ2=6.011,P=0.014)、谷丙转氨酶≤60U/L(χ2=5.064,P=0.024)、肿瘤侵及肝被膜(χ2=11.778,P=0.001)的患者显著增多。Logistic回归分析显示,与单纯肝内复发相比,肿瘤亚临床破裂型(OR=3.298,P=0.008)、谷丙转氨酶≤60U/L(OR=2.022,P=0.024)、肿瘤侵及肝被膜(OR=2.636,P=0.003)是发生肝外转移的独立危险因素。肝外转移最常见的脏器为肺、腹腔、骨骼和肾上腺等,其中接受手术切除、射频消融和索拉非尼等治疗患者的复发后生存时间高于仅对症治疗者。结论患者高龄、肿瘤大小、血管癌栓和肿瘤亚临床破裂与肝癌切除术后肝外转移的发生密切相关;对术后发生肝外转移患者,早期发现和治疗可提高患者复发后生存时间。

OBJECTIVE To analyze the survival outcomes and the influence factors of patients with extrahepatic metastasis after R0 resection for primary hepatocellular carcinoma （HCC）. METHODS The clinical data of 597 cases of primary HCC underwent R0 resection from January 2001 to December 2010 in Department of Hepatobiliary Surgery, Affiliated Hospital of Medical College Qingdao University were analyzed. RESULTS Median survival time after HC/2 recurrence in extrahepatic group was significantly worse than that in intrahepatic group（Log-rank test,X^2 =25. 2, P〈0. 001）. Logistic analysis demonstrated that age（OR=2. 555, P= 0. 003）, tumor size （OR = 2. 094, P = 0. 027）, history of tumor rupture （OR = 6. 407, P = 0. 010） and vascular tumor thrombus （OR=5. 267,P=0. 003）were independent risk factors for extrahepatic metastasis. Univariate analysis showed there were more patients with the factors of history of tumor rupture（x^2 =8. 261,P=0. 004）, HbsAg or Anti-HCV positive（X^2=6. 011,P=0. 014）, ALT ≤60 U/L （x^2= 5.064, P= 0. 024） or liver capsule invasion（x2 = 11.778,P= 0. 001） in extrahepatic group. Compared to intrahepatic recurrence, Logistic analysis demonstrated that history of tumor rupture （OR = 3. 298, P=0. 008）, ALT≤ 60 U/L （OR = 2. 022 ,P=0. 024） and liver capsule invasion（OR= 2. 636, P=0. 003） were independent risk factors for extrahepatic metastasis. The most common organs of extrahepatic metastasis were lung, abdomen, bone, adrenal gland, etc. Patients with treatment of surgery resection, radiofrequency ablation or sorafenib had a better survival. CONCLUSlONS Primary HCC patients with an old age, larger size tumor, history of tumor rupture or vascular tumor thrombus have a greater risk of extrahepatic metastasis. For patients with extrahepatic metastasis, earlier detection and more positive treatment can improve survival time.