乙型肝炎相关性孤立性大肝癌手术切除患者长期疗效及影响预后因素分析

Factors influencing long-term survival in patients with hepatocellular carcinoma with underlying hepatitis B virus infection after hepatectomy

目的探讨HBV相关孤立性大肝癌患者手术切除后长期疗效,并分析影响其预后的危险因素。方法2011年1月～2012年1月在我院行手术治疗的600例HBV相关肝癌患者,其中孤立性大肝癌130例,肿瘤直径>5 cm,小肝癌组470例,肿瘤直径≤5 cm。术后门诊随访超过5年,采用Kaplan-Meier法绘制生存曲线,采用Log-rank检验行生存分析,采用Logistic回归分析影响预后的因素。结果除孤立性大肝癌组肿瘤直径明显大于小肝癌组(P<0.05)外,其余临床特征的比较无统计学差异(P>0.05);470例小肝癌患者生存时间为(55.0±4.8)个月,无瘤生存时间为(38.6±2.4)个月,1 a、3 a和5 a生存率为90.1%、71.5%和57.1%,无瘤生存率为71.8%、47.0%和36.8%,而130例大肝癌患者生存时间为(50.0±3.6)个月(x^2=12.175,P=0.001),无瘤生存时间为(30.6±2.7)个月(x^2=0.669,P=0.102),1 a、3 a和5 a生存率为87.5%、58.4%和47.1%,无瘤生存率为66.8%、45.3%和32.8%;肿瘤直径5～10 cm的孤立性大肝癌患者总体生存率和无瘤生存率与小肝癌组比较无统计学差异(x^2=0.489,P=0.202;x^2=1.257,P=0.098),肿瘤直径>10 cm的患者总体生存率和无瘤生存率短于小肝癌患者,差异有统计学意义(x^2=15.271,P<0.001;x^2=8.124,P=0.013);多因素分析结果显示,HBV DNA载量(≥1×104 U/ml)和肿瘤直径(>10 cm)是影响患者5 a总生存率(OR=1.679,95%CI:0.987～2.341,P=0.025;OR=2.348,95%CI:1.024～4.357,P=0.013)和无瘤生存率(OR=2.365,95%CI:2.542～4.368,P=0.013;OR=2.674,95%CI:0.874～1.934,P=0.049)的独立危险因素。结论肿瘤直径在5～10 cm的孤立性大肝癌患者总体生存率和无瘤生存率与小肝癌患者类似,而肿瘤直径>10 cm的孤立性大肝癌患者总体生存率和无瘤生存率较小肝癌患者短。应针对影响预后的因素给予积极的处理措施,以延长患者术后生存。

Objective To investigate the factors influencing long -term survival in patients withhepatocellular carcinoma（HCC）with underlying hepatitis B virus（HBV）infection after hepatectomy. Methods600 patients with hepatitis B virus related single large HCC were recruited in our hospital between January 2011and January 2012,all patients received hepatectomy and followed-up for 5 years. Out of them, 130 cases hadtumors with diamiters greater than5 cm, and 470 had tumors with less than 5 cm. The survival curve was drawnby the Kaplan -Meier method, the survival analysis was estimated by Log-rank test, and the Logistic regressionanalysis was applied to analyze the prognostic factors. Results There was no significant differences as respect tothe clinical features（P〉0.05）except the diameter of the tumors in the two groups; in 470 patients with small livercancer, the survival time was 55.0±4.8 months, the tumor free survival time was 38.6±2.4 months, 1a, 3 a and 5aoverall survival rates were 90.1%, 71.5% and 57.1%, and the 1a, 3a and5a tumor free survival rate was57.1%, 71.5% and 57.1%, while in 130 patients with large liver cancer, the survival time was 50.0±3.6 months（x2=12.175, P=0.001）, the tumor free survival time was30.6±2.7 months（x2=0.669, P=0.102）, 1a, 3 a and 5aoverall survival rates were 87.5%, 58.4% and 47.1%,and the tumor free survival rates were 47.1%, 58.4%and 47.1% ; there were no significant differences asrespect to overall survival rates and disease -freesurvival rates between patients with large liver cancer（5~10 cm）and those with small liver cancer（x2=0.489, P=0.202; x2=1.257, P=0.098）; the overall survival rates and disease-free survival rates in patients with tumor greaterthan 10 cm were shorter than in with small liver cancer （x2=15.271, P〈0.001; x2=8.124, P=0.013）; multivariateanalysis showed that serum HBV DNA loads （≥1×104U/ml）and tumor size （〉10 cm）were the independent riskfactor for 5a overall survival rate （OR=1.679, 95% confidence interval：0.987~2.341; OR=2.348, P=0.025, 95% CI：1.024~4.357, P=0.013）and5a disease-free survival rate （OR=2.365, 95% CI：2.542~4.368, P=0.013; OR=2.674, 95%CI：0.874~1.934, P=0.049） . Conclusion The overall survival and disease-free survival in patients with large livercancer（5~10 cm）are similar with those in with small liver cancer, while the overall survival and disease-freesurvival in patients with tumors greater than 10 cm are poor. Measures should be taken to improve the prognosisof patients with large liver cancer.