术前肝纤维化指数对肝癌手术疗效及预后的影响

Effect of preoperative hepatic fibrosis index on the surgical outcome of hepatocellular carcinoma and prognosis

目的探讨术前肝纤维化指数(HFI)对肝癌手术疗效及预后的影响。方法 2011年4月至2015年4月,将北京大学深圳医院接受肝癌切除术的65例患者分为低指数组(HFI≤5.4)与高指数组(HFI>5.4)。分析两组术后疗效及预后情况。结果术前资料,两组性别、年龄、谷氨酰转肽酶、透明质酸、血小板、肝功能分级、HBV-DNA拷贝量比较,差异有统计学意义(均P<0.05)。术中、术后资料,两组肿瘤数目、肿瘤最大径、肝纤维化类型、术后血管侵犯情况、切缘情况、肝门静脉癌栓和HBVDNA变化比较,差异有统计学意义(均P<0.05)。低指数组并发症发生率20.0%,复发率23.3%,1、3、5年生存率分别为93.0%、53.0%、53.0%;高指数组并发症发生率22.9%,复发率25.7%,1、3、5年生存率分别为72.0%、29.0%、25.7%,两组生存率比较,差异有统计学意义(P<0.05)。肿瘤数目>3、HFI>5.4、肝、门静脉癌栓是肝癌术后复发的独立危险因素。结论术前肝纤维化指数对手术疗效及预后均有显著影响,是术后复发的独立危险因素。

Objective To study the effect of preoperative hepatic fibrosis index on the surgical outcome of hepatocellular carcinoma and prognosis. Methods A total of 65 patients who accepted operation for hepatocellular carcinoma in our hospital were taken as the retrospective analysis objects, and they were divided into the low index group （ HFI ≤5.4） and the high index group （ HFI 〉 5.4）. The effects of postoperative surgical outcome and hepatic fibrosis index on prognosis were analyzed. Results In preoperative data, there were significant differences in the two groups in sex ratio, age, GGT, HA, PLT, liver function classification and HBV- DNA copy quantity （P 〈0. 05 ） ; in perioperative and postoperative data, there were significant differences between the two groups in tumor number, tumor maximum diameter, hepatic fibrosis types, postoperative vascular invasion, incisal margin, hepatic portal vein tumor thrombus and HBV-DNA changes （P 〈 0. 05 ）. The inci- dence of postoperative complications and recurrence rate in the low index group were respectively 20% and 23. 3% which were lower than those in the high index group （22. 86% and 25. 7%, respectively） ; the survival rates of 1,3 and 5 years in the low index group were respectively 93%, 53% and 53% which were higher than those in the high index group （72%, 29% and 25.7%, respectively）, and their differences were statistically significant. Tumor number 〉 3 and FI 〉 5.4, liver and portal vein tumor thrombus would be independent risk factors for recurrence of hepatocellular carcinoma after operation （P 〈 0. 05）. Conclusions Preoperative hepatic fibrosis index which has obvious effect on both surgical outcome and prognosis is an independent risk factor for recurrence of hepatocellular carcinoma after operation.