术前丙氨酸氨基转移酶水平对合并肝硬化的肝癌患者R0切除术预后的影响

Impact of preoperative serum alanine aminotransferase level on the prognosis of hepatocellular carcinoma patients with liver cirrhosis after R0 resection

目的研究分析术前血清丙氨酸氨基转移酶(ALT)水平对合并肝硬化的肝细胞癌(LC-HCC)患者R0切除术预后的影响。方法回顾性分析2000年1月至2012年12月于我院获R0切除术的724例合并肝硬化的肝癌患者临床和随访资料。根据术前血清ALT水平,将患者分为增高组(ALT>50 U/L)和对照组(ALT≤50 U/L),并对比分析两组肝癌术后的结局。结果与对照组相比,增高组男性比例、年龄≤60岁比例、血小板<100×109/L比例、乙肝表面抗原(HBs Ag)阳性比例、侵及肝被膜比例、随访期间复发率和病死率较多。单因素分析显示,增高组的1、2、5、10年总体生存率和无瘤生存率明显比对照组要低(P<0.05)。Cox多因素分析显示,术前血小板<100×109/L、肿瘤多发、肿瘤直径>5 cm、血管癌栓及术前血清ALT>50 U/L是影响患者生存的独立危险因素;手术切缘<0.5 cm、肿瘤多发、肿瘤直径>5 cm、血管癌栓及术前血清ALT>50 U/L是影响患者复发的独立危险因素。结论术前血清ALT水平增高是预示合并肝硬化的肝癌患者R0切除术后预后的重要因素之一,其临床价值应被充分重视。

Objective To investigate the impact of serum alanine aminotransferase（ALT） level on the prognosis of patients with hepatocellular carcinoma complicated with liver cirrhosis（LC-HCC）.Methods The clinical and follow-up data of 724 cases of LC-HCC underwent R0 resection from Jan.2000 to Dec.2012 were analyzed retrospectively.According to preoperative ALT levels,the patients were divided into increased group（ALT〉50 U/L） and control group（ALT ≤ 50 U/L）,the postoperative outcomes in two groups were analyzed.Results Compared with the control group,male rate,age ≤ 60 years rate,platelet100 × 10^9/L rate,HBs Ag positive rate,liver capsule invasion rate,recurrence rate and death rate during follow-up were significant higher in the increased group.Univariate analysis showed the increased group was lower than the control group in overall survival and disease-free survival rate of 1-,2-,5-,10-year（P〈0.05）.Cox regression model analysis suggested that the independent risk factors that affecting postoperative survival included preoperative platelet level,multiple tumors,diameter of tumor,vascular invasion and preoperative serum ALT level.The independent risk factors that affecting tumor recurrence included resection margin,multiple tumors,diameter of tumor,vascular invasion and preoperative serum ALT level.Conclusion The increase of preoperative serum ALT level is one of the important factors which can predict the prognosis of cirrhotic HCC patients after R0 resection,and its clinical value should be fully appreciated.