大肝细胞癌切除术后预后的相关因素分析

Predictiors of Survival of Large Hepatocellular Carcinoma After Hepatic Resection

目的探讨影响大肝癌(直径≥5 cm且<10 cm)根治术后生存的预后因素。方法对行手术切除获得随访的170例大肝癌患者的性别、年龄、血清HBs Ag等相关因素进行分析。用寿命表法计算肝癌术后1、3、5年总生存率和无瘤生存率,生存分析采用Kaplan-Meier法,采用Log-rank方法对相关因素进行单因素分析,采用Cox模型进行多因素分析。结果大肝癌术后1、3、5年生存率分别为74.6%、48.2%、35.8%,单因素分析结果提示术前甲胎蛋白(AFP)、门脉癌栓及术后复发是影响大肝癌术后总生存的预后因素(P<0.05);多因素分析提示门脉癌栓及术后复发是影响手术后总生存的独立危险因素(P<0.05)。结论术前AFP、门脉癌栓及术后复发是影响大肝癌术后总生存率的预后因素;门脉癌栓及术后复发是影响手术后总生存的独立危险因素。

Objective To explore the predictors of survival of large hepatocellular carcinoma（ HCC） after hepatic resection. Methods One hundred and seventy patients with HCC who underwent hepatic resection were reviewed. For each patient,gender,age,HBs Ag,and so on were extracted. The 1-,3- and 5-year overall survival rates as well as disease-free survival rates were calculated with life table method. Kaplan-Meier estimation was applied to a survival analysis. Log-rank test was used to conduct univariate analysis on the related factors,while COX model was applied to multivariate analysis.Results The estimated 1-,3-,and 5-year overall survival rates for large HCC were 74. 6%,48. 2%,and 35. 8%,respectively.Univariate analysis presented that preoperative alpha-fetoprotein（ AFP）,portal vein tumor thrombus,and postoperative recurrence were the prognostic factors of survival for large HCC patients（ P〈0. 05）. Multivariate analysis showed that portal vein tumor thrombus and postoperative recurrence were independent risk factors of overall survival for patients with large HCC after operation（ P〈0. 05）. Conclusion The prognostic factors of survival for large HCC patients after hepatic resection are preoperative AFP,portal vein tumor thrombus,and postoperative recurrence. Portal vein tumor thrombus and postoperative recurrence are independent risk factors of survival for large HCC.