肝细胞性肝癌手术治疗的疗效及影响因素观察

Observation on the efficacy of surgical treatment of hepatocellular carcinoma and its influencing factors

目的研究并探讨手术治疗肝细胞性肝癌的临床疗效,并分析影响肝细胞性肝癌疗效的危险因素,为完善肝细胞性肝癌手术治疗提供参考依据。方法入组对象选择2013年1月~2017年9月期间在我院接受手术治疗且完成3年术后随访的200例肝细胞性肝癌患者,对其手术疗效进行评估。根据200例肝细胞性肝癌患者随访3年存活情况,将其分为存活组、死亡组,比较两组临床资料,对影响肝细胞性肝癌手术预后的危险因素进行单因素分析、多因素Logistic线性回归分析。结果 200例肝细胞性肝癌患者经手术治疗后,其短期客观缓解率为63.50%,术后均未发生并发症,其复发率为24.50%,3年存活率、死亡率分别为79.00%、21.00%。单因素分析中,两组在肿瘤直径、肿瘤分化程度、肿瘤间质细胞比、血管侵犯、术前甲胎蛋白水平等方面比较差异均有统计学意义(P<0.05),而经多因素Logistic线性回归分析后发现,肿瘤直径≥5 cm、肿瘤分化程度低、肿瘤间质细胞比<50%、血管侵犯、术前甲胎蛋白水平≥400 ng/m L是影响肝细胞性肝癌患者手术预后的危险因素。结论肝细胞性肝癌患者手术治疗后的预后受到肿瘤直径、肿瘤分化程度、肿瘤间质细胞比、血管侵犯、术前甲胎蛋白水平的影响,临床上需针对相关危险因素合理调整手术方案。

Objective To study and discuss the clinical efficacy of surgical treatment of hepatoceltular carcinoma（HCC） and to analyze the risk factors affecting the therapeutic effect of hepatocellular carcinoma （HCC）, so as to provide refer ences for improving the surgical treatment of hepatocellular carcinoma. Methods The enrolled subjects were selected from 200 patients with hepatocellular carcinoma who underwent surgery in our hospital from January 2013 to September 2017 and were followed up for 3 years. The efficacy of surgery was evaluated. According to the survival conditions of these 200 patients with hepatocellular carcinoma who were followed up for 3 years, they were divided into survival group and death group, and the clinical data were compared between the two groups. The risk factors affecting the sur- gical prognosis of hepatocellular carcinoma were analyzed by univariate analysis and multivariate Logistic linear regres- sion analysis. Results After surgical treatment for 200 patients with hepatocellular carcinoma, the short-term objective response rate was 63.50%. No postoperative complications were observed, and the recurrence rate was 24.50%. Three- year survival rate and mortality rate were 79.00% and 21.00% respectively. In univariate analysis, the differences be- tween two groups were statistically significant in terms of tumor diameter, tumor differentiation, tumor stromal cell ratio, vascular invasion, and preoperative alpha-fetoprotein levels（P〈0.05）. The multivariate Logistic linear regression analysis found that, tumor diameter ≥ 5 cm, low tumor differentiation, tumor stromal cell ratio 〈50%, vascular invasion, preop- erative alpha-fetoprotein level ≥400 ng/mL were risk factors for the surgical prognosis in the patients with hepatocellular carcinoma. Conclusion The prognosis of patients with hepatocellular carcinoma after surgery is affected by tumor diameter, tumor differentiation, tumor stromal cell ratio, vascular invasion, and preoperative alpha-fetoprotein level. The surgical regimen should be appropriately adjusted in clinical settings regarding relevant risk factors.