原发性肝癌手术切除术后复发的影响因素分析

Analysis of influencing factors on recurrence of primary liver cancer after resection

目的探讨肝癌患者手术后复发的相关因素,为延长患者生存时间,促进术后康复提供指导依据。方法选取梧州市红十字会医院肝胆外科2014年1月至2016年6月期间接受肝癌外科手术切除治疗的162例肝癌患者,收集患者的临床资料,并随访跟踪2年,探索临床指征、生活方式、饮食等因素与肿瘤复发和患者生存的关系。结果术后2年内,共85例肝癌患者复发,肿瘤复发率为52.5%;单因素分析结果显示,超重肥胖、肿瘤直径、肝硬化、肿瘤包膜完整性和门静脉是否受浸润与肝癌2年内复发相关(P<0.05);未复发者的蔬菜和水果的平均每周摄入量高于复发组,差异均具有统计学意义(P<0.05);在校正了性别、民族、职业和收入等因素后,Logistics回归分析结果显示,年龄>50岁、合并有高血压、高血糖、肿瘤直径>5 cm、超重肥胖、患有肝硬化、门静脉已受浸润、肿瘤多结节发病和肿瘤包膜不完整与增加肝癌复发风险相关(OR值均>1.00,P值均<0.05);术后接受辅助治疗、蔬菜类摄入>1 500 g/周和水果类摄入>500 g/周则可能与降低肝癌复发风险相关(OR值均<1.00,P值均<0.05)。结论肿瘤直径、门静脉受浸润、肿瘤多结节发病和肿瘤包膜不完整,以及高血压、高血糖、超重和肥胖、肝硬化可用于评估患者复发的危险性,术后积极开展辅助治疗,积极进行饮食调理,对延长患者无瘤生存期具有一定的临床价值。

Objective To explore the related factors of postoperative recurrence in patients with hepatocellular carcinoma（HCC）, and to provide guidance for prolonging the survival time of patients and promoting postoperative rehabilitation. Methods A total of 162 patients with HCC undergoing surgical resection from January 2014 to June 2016 in the Department of Hepatobiliary Surgery of Wuzhou Red Cross Hospital were included in the study. The clinical data of the patients were collected and followed up for 2 years. The relationship between clinical indications, lifestyle, diet and tumor recurrence and survival of patients were explored. Results Within 2 years after operation, there were 85 cases of HCC recurred, and the recurrence rate was 52.5%. Univariate analysis showed that overweight and obesity, tumor diameter, liver cirrhosis, tumor capsule integrity and portal vein infiltration were associated with liver cancer recurrence within2 years（P〈0.05）. The average weekly intake of vegetables and fruits in the patients without recurrence was higher than that in the the patients with recurrence, with statistically significant difference（P〈0.05）. After adjusting for sex, nationality, occupation and income, the results of logistic analysis regression showed that age〉50 years, complicated with hypertension or hyperglycemia, tumor diameter〉5 cm, overweight and obesity, cirrhosis, the infiltrated portal vein, tumor nodules disease and the incompleteness of the tumor were associated with increased risk of HCC recurrence（OR〉1.00, P〈0.05）. Postoperative adjuvant therapy, vegetables intake〉1 500 g/week, fruits intake〉500 g/week were associated with decreased risk of HCC recurrence（OR〈1.00, P〈0.05）. Conclusion Characteristics as diameter of the tumor, the infiltrated portal vein, multiple noduled involvement and the incompleteness of tumor capsule, hypertension, hyperglycemia,overweight and obesity, cirrhosis can be used to assess the risk of recurrence. Actively carrying out adjuvant therapy and diet adjustment after operation can help extend the tumor-free survival time.