符合米兰标准的肝细胞肝癌肝切除术后预后影响因素分析

Analysis of Prognosis Factors of Hepatocellular Carcinoma Within Milan Criteria after Liver Resection

目的分析影响符合米兰标准的肝细胞肝癌肝切除术后预后的影响因素。方法回顾性分析2007~2013年期间267例于笔者所在医院行肝切除的肝细胞肝癌患者的资料。将患者的术前资料、肿瘤特征等予以单因素分析及多因素分析。结果 267例患者中有123例患者术后出现肿瘤复发,其复发时间2.7~75.1个月,均数为（16.9±14.5）个月;51例患者死亡,死亡时间6.1~75.4个月,均数为（27.5±16.4）个月。患者术后1、3及5年累积无瘤生存率分别为76.8%、56.3%和47.6%,累积生存率为96.6%、82.5%和74.5%。多因素分析显示,肿瘤分化程度、肿瘤微血管侵犯及多发肿瘤是肝癌切除术后肿瘤复发的独立危险因素,而肿瘤分化程度、术前HBVDNA阳性和术前中性粒细胞与淋巴细胞比值是影响患者生存的独立危险因素。结论肿瘤分化程度、肿瘤微血管侵犯和多发肿瘤影响符合米兰标准的肝细胞肝癌患者肝切除术后肿瘤复发,而肿瘤分化程度、术前HBV-DNA阳性和术前中性粒细胞与淋巴细胞比值影响患者的长期生存。

Objective To identify the risk factors of postoperative recurrence and survival for patients with hepa- tocellular carcinoma within Milan criteria following liver resection. Methods Data of 267 patients with hepatocellular carcinoma within Milan criteria who received liver resection between 2007 and 2013 in our hospital were retrospectively analyzed. Results Among the 267 patients, 123 patients suffered from recurrence and 51 patients died. The mean time to recurrence were （16.9±14.5） months （2.7-75.1 months）, whereas the mean time to death were （27.5±16.4） months （6.1-75.4 months）. The recurrence-free survival rates in i-, 3-, and 5-year after operation was 76.8%, 56.3%, and 47.6%, respectively; whereas the overall survival rates in 1-, 3-, and 5-year after operation was 96.6%, 82.5%, and 74.5%, respec- tively. Multivariate analyses suggested the tumor differentiation, microvascular invasion, and multiple tumors were inde- pendent risk factors for postoperative recurrence; whereas the tumor differentiation, positive preoperative HBV-DNA load, and preoperative neutrophil-to-lymphocyte ratio adversely influenced the postoperative survival. Conclusions For patients with hepatoceUular carcinoma within Milan criteria after liver resection, the tumor differentiation, microvascular invasion, and multiple tumors contribute to postoperative recurrence; whereas the tumor differentiation, positive preoperative HBV-DNA load, and preoperative neutrophil-to-lymphocyte ratio adversely influence the postoperative survival.