原发性肝细胞癌切除术后复发的危险因素分析

Risk factors for recurrence after resection of primary hepatocellular carcinoma

目的分析原发性肝细胞癌切除术后复发的相关危险因素。方法对2012年1月—2016年12月江汉大学附属医院肿瘤科行肝癌切除术且术后病理确诊为肝细胞癌患者105例进行回顾性分析。将手术后2年内出现复发者74例纳入复发组,2年内未出现复发者31例纳入未复发组,多因素Logistic回归分析原发性肝癌术后复发的危险因素。结果单因素分析表明HBV-DNA、吲哚氰绿15 min内滞留率(ICG-R15)、肿瘤数目和直径、肿瘤包膜和门脉癌栓的有无、术中输血、肿瘤的分期与分化程度是原发性肝细胞癌术后复发影响因素(χ~2=5.595,P=0.029;χ~2=4.408.P=0.037;χ~2=4.652,P=0.033;χ~2=6.521,P=0.013;t=3.483,P=0.048;t=5.908,P=0.019;χ~2=5.871,P=0.022;χ~2=3.455,P=0.041;χ~2=6.697,P=0.011),多因素Logistic回归分析发现,原发性肝细胞癌术后复发的独立危险因素,包括HBV-DNA高拷贝、多发肿瘤、肿瘤直径≥5 cm、门脉癌栓形成以及术中输血量≥800 ml。结论对于原发性肝细胞癌切除术患者,术前HBV-DNA高拷贝、多发肿瘤、肿瘤直径≥5 cm、门脉癌栓形成及术中输血量≥800 ml的患者术后有着较高的复发风险。

Objective To analyze the risk factors of recurrence after resection of primary hepatocellular carcinoma.Methods From January 2012 to December 2016, 105 patients pathologically confirmed as primary liver cancer after hepatectomy were retrospectively analyzed. The patients who had in two years after hepatectomy were divided into the recurrent group,and those who did not have recurrence were divided into the non-recurrent group. The risk factors of recurrence of primary hepatocellular carcinoma after hepatactomy were evaluated with multivariate logistical analysis. Results The univariate analysis showed that HBV DNA（ χ^2 =5. 595,P =0. 029）, ICG-R15（ χ^2 =4. 408,P =0. 037）, the number and size of the tumor（χ^2=4. 652,P =0. 033;χ^2 =6. 521,P = 0. 013）, the completeness degree of tumor capsule（ t = 3. 483,P = 0. 048）, tumor thrombus of the portal vein（t = 5. 908,P =0. 019）, the intra-operative blood transfusion（χ^2 =5. 871.P =0. 022）. tumor staging（ χ^2=-3.455,P =0. 041） and tumor differentiation（χ^2 =6. 697,P=0. 011） were associated with the recurrence of primary hepatocellular carcinoma after hepatactomy. The logistical regression analysis showed that the high copy of HBV-DNA,the size of tumor（ ≥5 cm）,multiple tumors,tumor thrombus of the portal vein and the intraoperative blood transfusion（ ≥800 ml） were the independent risked factors of recurrence of primary hepatocellular carcinoma after hepatactomy. Conclusion The patients with high copy of HBV-DNA,the size of tumor（ ≥5 cm）,multiple tumors,tumor thrombus of the portal vein and the intraoperative blood transfusion（ ≥800 ml） are more likely to result in recurrence of primary hepatocellular carcinoma after hepatactomy.