应用内镜技术诊断鼻咽癌放疗后鼻咽颅底病变的价值

Value of the endoscopic diagnosis on the lesions of the skull base in postradiotherapeutic patients with nasopharyngeal carcinoma

目的分析小肝癌患者的临床病理特征及预后影响因素。方法回顾性分析2009年1月至2013年12月间行R0切除的98例小肝癌患者的临床病理资料和随访资料。结果98例患者全部获得随访，98例患者术后1、3、5年生存率分别为99.0%、91.7%和76.3%，中位总生存时间（OS）为52个月。98例患者术后1、3、5年无进展生存率分别为86.7%、66.2%和55.0%，中位无进展生存时间（PFS）为43.5个月。单因素分析显示，卫星结节、肝被膜侵犯和术后复发时间与总生存有关（均P〈0.05），长期大量饮酒、卫星结节和肝被膜侵犯与无进展生存有关（均P〈0.05）。多因素分析显示，术后复发时间和肝被膜侵犯是影响小肝癌患者总生存的独立因素（均P〈0.05），长期大量饮酒是影响小肝癌无进展生存的独立因素（P＝0.003）。结论小肝癌的治疗仍是以手术为主的积极治疗，在保证肿瘤R0切除的前提下，尽量减少正常肝的切除范围对患者有利。小肝癌术后复发时间≤2年提示预后不良，长期大量饮酒能够促进小肝癌术后复发。

ObjectiveTo analyze the clinicopathological features and prognosis of patients with small hepatocellular carcinoma.MethodsThe clinicopathological and follow-up data of 98 patients with small hepatocellular carcinoma who underwent R0 resection from January 2009 to December 2013 were analyzed retrospectively.ResultsAll of the patients were followed up. Their postoperative 1-year, 3-year and 5-year overall survival rates were 99.0%, 91.7%, and 76.3%, respectively. Their postoperative median overall survival （OS） period was 52 months. The postoperative progression-free survival rates were 86.7%, 66.2% and 55.0%, respectively, and the median progression-free survival （PFS） period was 43.5 months. The univariate analysis showed that satellite nodules, liver capsule invasion and postoperative recurrence time were associated with OS （P〈0.05）, and long-term heavy drinking, satellite nodules and liver capsule invasion with PFS （P〈0.05）. The multivariate analysis indicated that long-term heavy drinking was an independent factor influencing the progression-free survival period of patients with small hepatocellular carcinoma （P=0.003） and postoperative recurrence time and liver capsule invasion were independent factors affecting their overall survival period （P〈0.05）.ConclusionsThe treatment of small hepatocellular carcinoma still concentrates on the active treatment of surgery. It is beneficial to patients to minimize the resection scope of normal liver under the premise of R0 removal of tumor. Postoperative recurrence time of ≤2 years suggests poor prognosis of small hepatocellular carcinoma. Long-term heavy drinking can accelerate the recurrence of small hepatocellular carcinoma.