肝纤维化指数与肝癌手术预后的相关性

A correlation between liver fibroindex and prognosis of hepatocellular carcinoma after hepatectomy

目的研究术前肝纤维化指数与肝癌肝切除患者预后的相关性。方法对2009年10月至2014年12月中山大学附属第五医院肝胆外科77例肝癌肝切除患者的临床资料进行回顾性分析。根据术前肝纤维化指数将患者分为低指数组（肝纤维化指数≤5．4，n=35）和高指数组（肝纤维化指数〉5．4，n=42），分析两组患者临床病理学参数及术后无瘤生存的统计学差异。以Cox回归模型对其术后复发情况进行相关因素分析。结果低指数与高指数两组患者性别分布（35／0比29／13）、肝硬化类型（23／12比14／28）、肿瘤数目（35／0比26／16）、最大直径（31／4比23／19）、血管侵犯（32／3比26／16）、切缘阳性（35／0比36／6）、肝静脉或门静脉癌栓情况（35／0比29／13）、HBVDNA手术前后数量级变化情况（23／12比15／27）及术后复发率差异具有统计学意义（P〈0．05）。肝纤维化指数〉5．4组无瘤生存率（71．4％、33．7％、22．4％）低于肝纤维化指数≤5．4组（94．3％、46．2％、46．2％）（P〈0．05）。Cox回归分析提示术前甲胎蛋白异质体L3≥10％、肝纤维化指数〉5．4、术前肿瘤数目〉3个是肝癌术后复发的独立危险因素（P〈0．05）。结论术前肝纤维化指数〉5．4是影响肝癌肝切除患者术后复发的独立危险因素，对于预测肝癌肝切除患者的预后具有一定的价值。

Objective To study the correlation between liver fibroindex and prognosis of hepatoeel- lular carcinoma after hepatectomy. Methods The clinical data of 77 patients with hepatocellular carcinoma who underwent hepatectomy at the 5th Hospital Affiliated to Sun Yat-sen University from 2009 October to 2014 December were analyzed retrospectively. Using data from preoperative Fibroindex, these patients were divided into 2 groups, Group 1 ： Fibroindex ≤5.4, and Group 2： Fibroindex 〉 5.4. The clinical pathologi- cal parameters and postoperative disease free survival rates in these groups were analyzed. The Cox ratio risk pattern analysis was used for factors correlating recurrence. Results The parameters in the 2 groups which included sex （35/0 vs 29/13 ）, type of cirrhosis （23/12 vs 14/28 ） , numbers of tumor （35/0 vs 26/16） , maximal diameter of tumor （31/4 vs 23/19）, vascular invasion status （32/3 vs 26/16）, resection margin status （35/0 vs 36/6）, hepatic vein/portal vein tumor thrombus status （35/0 vs 29/13）, perioperative change of HBV DNA levels （23/12 vs 15/27）were correlated with postoperative recurrence, and they all showed significant differences （P 〈 0.05 ）. Disease free survival rate in Group 2 was lower than Group 1 （71.4%, 33.7% , 22.4% vs 94.3% , 46.2% , 46.2% , P 〈 0. 05）. The Cox regression analysis showed Fibroindex 〉 5.4, AFP-L3% ≥10% , and number of tumor 〉 3 to be independent predictors of poor dis- ease-free survival after hepatectomy for hepatoeellular carcinoma （P 〈 0.05）. Conclusions Preoperative Fibroindex 〉 5.4 was an independent adverse predictor of poor disease-free survival. It was valuable to pre- dict postoperative recurrence in hepatocellular carcinoma patients.