肝细胞癌根治性切除术后生存十年以上的预后因素分析

Clinicopathologic features of hepatocellular carcinoma patients surviving more than 10 years after radical hepatectomy

目的：探讨肝细胞癌根治性切除术后生存10年以上患者的预后因素。方法收集1999年1月至2006年3月在青岛大学附属医院行根治性肝切除治疗的252例肝细胞癌患者的临床、病理和随访资料。男性217例，女性35例，年龄17～82岁，平均（53.8±10.5）岁。按术后生存时间分为＞10年组和≤10年组。随访时间截至2016年3月31日。采用χ^2检验、Kaplan.Meier生存分析（ Log.rank检验）及Cox风险比例模型分析影响患者长期生存的预后因素。结果252例患者随访4.0～205.7个月，中位随访时间为53.4个月。10年累积生存率为26％，66例患者生存时间＞10年（26.2％），其中40例无肝细胞癌复发征象。生存＞10年组与生存≤10年组比较，术前ALT＜40 U／L、谷酰转肽酶＜64 U／L、清蛋白≥35 g／L、不伴有肝硬化、无门静脉高压症、肝功能Child.Pugh分级A级、无输血、术前甲胎蛋白≤20μg／L、主瘤瘤径≤5.0 cm、单发肿瘤、组织学高分化、TNM分期Ⅰ期和术后动脉化疗栓塞（ TACE ）阴性（无肿瘤染色且无碘油沉淀）患者比例的差异有统计学意义（ P 值均＜0.05）；Cox回归风险模型分析结果表明，Child.Pugh分级A级（ RR＝6.813，P＝0.031）、术后TACE阴性（ RR＝2.467，P＝0.001）和主瘤瘤径≤5.0 cm（ RR＝1.684，P＝0.025）是肝细胞癌患者根治性切除术后生存10年以上的有利的独立因素。结论术前肝功能Child.Pugh分级A级、术后TACE阴性和主瘤瘤径≤5.0 cm是10年生存相关的有利的独立因素。单发、无血管侵犯的小肝癌是根治性切除后获长期生存的重要条件。术后TACE阳性是肿瘤复发或再发的高危状态，应给予积极的综合治疗。

Objective To clarify the clinicopathologic features of hepatocellular carcinoma （ HCC） patients survived more than 10 years after radical hepatectomy. Methods Two hundreds and fifty.two patients who underwent curative resection for HCC between January 1999 and March 2006 at Department of Hepatopancreatobiliary Surgery,Affiliated Hospital of Qingdao University were included.There were 217 male cases and 35 female cases aging from 17 to 82 years with median age of （53.8±10.5）years. Followed by March 31 2016, clinicopathologic factors in 10-year survivors and patients who died within 10 years were compared by χ^2 test,Kaplan.Meier survival analysis and Cox proportional hazards model and the prognostic factors affecting survival were identified. Results All patients were followed.up for 4.0 to 205.7 months with median time of 53.4 months. The 10.year overall survival rate was 26%,there were 62 cases（ 26.2%） who survived for more than 10 years after initial hepatectomy. In survival 〉10.year group,the paitents with ALT〈40 U/L,gamma.glutamyl transpeptidase〈64 U/L,albumin≥35 g/L,without liver cirrhosis and portal hypertension,Child.Pugh grade A,no blood transfusion,AFP≤20μg/L,tumor size≤5.0 cm,single tumor, high differentiation,TNM stage Ⅰ and TACE negative after resection were more than the patients in survival〈10.year group （P〈0.05）.In multivariate analysis,Child.Pugh grade A,the tumor size ≤5.0 cm and TACE negative after resection were favorable independent factors associated with 10.year survival （ P〈0.05） . Conclusion Based on the results of the study, Child.Pugh grade A, tumor size ≤5.0 cm and＆amp;nbsp;TACE negative after resection at initial hepatectomy might be biologically favorable conditions for patients surviving more than 10 years.