162例巴塞罗那B期肝癌患者肝切除术预后及亚组分析

Prognostic and subgroup analysis of 162 patients with Barcelona Clinical Liver Cancer （BCLC）stage B hepatocellular carcinoma after hepatectomy

目的 探讨巴塞罗那B期肝癌患者手术治疗预后及其危险因素.方法 回顾性分析2007年6月至2013年12月在天津医科大学肿瘤医院及天津医科大学第二医院进行肝切除的162例巴塞罗那B期肝癌患者的临床资料.分析年龄、性别等因素对长期生存结果的影响,然后在此基础上进行亚组分析.结果 肿瘤多发、肿瘤最大径＞ 10 cm和AFP＞ 100 μg/L是影响巴塞罗那B期肝癌患者术后总体生存率的独立危险因素.根据上述危险因素将巴塞罗那B期肝癌患者分为低危亚组（无危险因素和1个危险因素）和高危亚组（≥2个危险因素）.低危亚组1、3、5年生存率分别为91.6％、65.5％、61.9％,平均生存时间（72.1±4.1）个月;高危亚组1、3、5年生存率分别为67.4％、25.6％、10.8％,平均生存时间（29.1±4.2）个月;全部患者1、3、5年生存率分别为85.2％、54.9％、48.0％,平均生存时间（60.5±3.6）个月.结论 巴塞罗那B期肝癌患者进行肝切除可获得相对满意的长期生存结果.肿瘤多发、肿瘤最大径＞10 cm和AFP＞ 100 μg/L是影响术后生存的独立危险因素,根据上述危险因素可将巴塞罗那B期肝癌患者分为高危亚组和低危亚组,低危亚组患者的生存率显著优于高危亚组.

Objectives To analyze prognosis and risk factors of Barcelona Clinical Liver Cancer （BCLC） stage B hepatocellular carcinoma patients treated with hepatectomy.Methods Clinical data of 162 BCLC stage B patients who underwent hepatectomy at Tianjin Medical University Cancer Institute ＆ Hospital and the Second Hospital of Tianjin Medical University from June 2007 to December 2013 were retrospectively studied.The correlations between factors （age,gender） and long-term outcome were analyzed to determine independent risk factors.Subsequently,subgroup analysis of BCLC stage B hepatocellular carcinoma was performed.Results Multiple tumors,maximum tumor diameter 〉 10 cm and AFP 〉 100 μg/L were con firmed as independent risk factors of overall survival in postoperative BCLC B patients.Based on the risk factors,patients were divided into two groups,namely low-risk subgroup （≤ 1 risk factor） and high-risk subgroup （≥ 2 risk factors）.In low-risk subgroup,1,3 and 5-year overall survival （OS） rates were 91.6%,65.5%,61.9% respectively,and mean OS was 72 months.By contrast,1,3 and 5-year OS rates in high-risk subgroup were 67.4%,25.6%,10.8% respectively,and mean OS was 29 months.Further more,1,3 and 5-year OS rates of all patients were 85.2%,54.9%,48.0% respectively,and mean OS was 61 months.Conclusions Relatively favorable long-term outcomes could be yielded in BCLC stage B hepatocellular carcinoma patients treated with liver resection.The independent risk factors including multiple tumors,maximum tumor diameter 〉 10 cm and AFP 〉 100 μg/L were closely correlated with overall survival.BCLC stage B hepatocellular carcinoma patients could be divided into low-risk and high-risk subgroups based on the risk factors mentioned above.Survival rates in low-risk subgroup are remarkably superior to those in high-risk subgroup.