巴塞罗那分期0-A期肝细胞肝癌术后复发危险因素分析

Analysis of risk factors of recurrence in patients with BCLC 0-A hepatocellular carcinoma after surgical resection

目的 分析了解巴塞罗那分期0-A期肝细胞肝癌复发因素.方法 回顾性分析2006年12月1日至2013年7月30日间中国医学科学院肿瘤医院同一治疗团队进行外科治疗的218例巴塞罗那分期0-A期肝细胞肝癌患者的临床资料,应用Kaplan-Meier方法计算生存时间,Cox回归法对17个可能与复发及预后相关的临床病理因素进行统计学分析.结果 218例患者全部获得随访,术后1、3、5年总生存率分别为95.9％、85.3％和67.6％,中位生存期35.0个月.1、3、5年无病生存率为84.4％、56.5％、47.0％,中位无复发生存期25个月.单因素分析显示合并肝硬化、甲胎蛋白（AFP）阳性、卫星病灶、肿瘤累及肝被膜、肿瘤分化、脉管瘤栓与患者复发有关,Cox多因素分析显示卫星结节、脉管瘤栓、肿瘤累及肝被膜是患者复发的独立因素.结论 外科治疗是巴塞罗那分期0-A期肝细胞肝癌的首选,卫星结节、脉管瘤栓、肿瘤累及肝被膜是患者复发的独立因素,对于有复发危险因素的患者术后行介入治疗不能延长患者生存时间.

Objecfive To analyze the risk factors of recurrence in patients with Barcelona Clinic Liver Cancer （BCLC） 0-A hepatocellular carcinoma （HCC） after surgical resection.Methods Retrospective analyses were conducted for 218 patients undergoing surgical resection for BCLC 0-A HCC.A total of 17 clinicopathologic factors possibly influencing the recurrence and survival were selected.And multivariate analysis of these parameters was performed with Cox proportional hazard model.Survival analysis was performed with the Kaplan-Meier method.Results The overall 1,3,5-year survival rates were 95.9%,85.3% and 67.6% respectively.The median survival from time of primary resection was 35 months.The overall 1,3 and 5-year disease-free survival （DFS） rates were 84.4%,56.5% and 47.0% respectively.Univariate analysis showed that cirrhosis,positive alpha-fetoprotein （AFP）,satellite nodules,involvement of hepatic capsule,tumor differentiation and microvascular invasion were associated with recurrence.And Cox multivariate analysis showed that satellite nodules,involvement of hepatic capsule and microvascular invasion were the independent risk factors for recurrence.Conclusion Surgical resection is a first option for BCLC 0-A HCC.Satellite nodules,involvement of hepatic capsule and microvascular invasion are independent risk factors for recurrence.Postoperative transarterial chemoembolization does not benefit the survival of patients with risk factors of recurrence.