原发性肝癌的治疗方法与术后肿瘤复发和生活质量的关系

Analysis of the Relationship Between Surgical Treatment and Postoperative Tumor Recurrence and Postoperative Quality of Life in Patients with Primary Liver Cancer

【目的】探讨原发性肝癌（PLC）外科治疗方法与患者术后肿瘤复发和生活质量之间的关联性。【方法】根据治疗方式不同，将358例PLC患者分为两组，肝叶切除组（n-308）和肝移植组（n=50）。根据肝功能差异，将肝切除病人分为中重度肝硬化组（n=34）、轻度肝硬化组（n=230）和无肝硬化组（n=44）。比较两组患者术后生存率、肿瘤复发率和生活质量。【结果】肝叶切除组1、3、5累积生存率和复发率与肝移植组比较差异无显著性（P〉0．05）；但中重度肝硬化患者3年、5年生存率低于轻度肝硬化、无肝硬化患者；1、3、5累积生复发率高于轻度、无肝硬化患者，且差异有显著性（P〈0．01），轻度与无肝硬化患者组间比较差异无显著性（P〉0．05）。肝叶切除组患者躯体功能（PH）、心理功能（PS）、症状／副作用（ST）、社会功能（SO）、自我评价及总分均低于肝移植组（P〈0．01）。PLC患者的手术方法、肝硬化程度与肿瘤复发率和患者的生活质量密切相关。【结论】肝叶切除治疗无硬化或轻度肝硬化PLC与肝移植比较其近远期疗效接近，但中重度肝硬化患者行肝叶切除其肿瘤复发率较高，术后生活质量低。

[Objective]To analyze the relationship between surgical treatment and postoperative tumor re eurrence and postoperative quality of life in patients with primary liver cancer （PLC）. [Methods]A total of 358 patients with PLC were divided into the liver resection group （ n ：308） and the liver transplantation group （ n =50）. According to different liver function, the patients were further divided into the moderate to severe cir- rhosis group （ n =34）, mild cirrhosis group （ n =230） and non cirrhosis group （ n =44）. The postoperative survival rate, tumor reeurrence rate and quality of life were eompared between the two groups. [Results]There were no significant differences in I, 3 and 5-year cumulative survival rates and cumulative recurrence rate be- tween the liver resection group and the liver transplantation group （ P 〉0.05）. The 3-year and 5 year survival rates of patients with moderate to severe liver cirrhosis were lower and the 1-year, 3-year and 5-year cumula- tive recurrence rates were higher than in the mild cirrhosis patients and the patients without cirrhosis （ P 〈0.01）. However, there was no significant difference between the mild cirrhosis group and the non cirrhosis （ P 〉0.05）. The scores of physical function （PH）, mental function （PS）, symptoms/side effects （ST）, social function （SO）, self-evaluation and the total score were lower in the liver resection group than the liver trans- plantation group （ P 〈0.01）. Correlation analysis showed that the two operation methods and the degree of liver cirrhosis were closely related to tumor recurrence rate and quality of life. [Conclusion] The short term and long-term curative effects of liver resection and liver transplantation are similar in the treatment of nowcir- rhosis or mild cirrhosis. However, the tumor recurrence rate is high in patients with moderate to severe liver cirrhosis after liver resection, which will decrease the quality of life.