肝癌患者术后生存的影响因素分析

Analysis of the influencing factors of postoperative survival in patients with hepatocellular carcinoma

目的探讨肝癌患者术后生存的相关影响因素,为临床决策提供指导。方法收集136例行肝癌切除术的肝癌患者的临床资料。所有患者术后均采用电话及门诊等方式进行随访,了解生存情况。对肝癌患者术后生存影响因素进行分析。结果136例患者中,术后复发72例,死亡46例,RFS为1.2~78.0个月,中位RFS为32个月,OS为1.6~79.6个月,中位OS为38个月。不同AST、清蛋白、NLR、甲胎蛋白、肿瘤最大径、TNM分期、BCLC分期及有无癌栓患者的中位RFS比较,差异均有统计学意义(P﹤0.05);不同AST、清蛋白、NLR、肿瘤最大径、TNM分期、BCLC分期及有无癌栓患者的中位OS比较,差异均有统计学意义(P﹤0.05)。多因素Cox比例风险模型回归分析结果显示,术前外周血清NLR及TNM分期、BCLC分期是肝癌患者术后RFS的独立影响因素(P﹤0.05);清蛋白、NLR、肿瘤最大径、TNM分期是肝癌患者术后OS的独立影响因素(P﹤0.05)。结论术前外周血清蛋白、NLR、肿瘤最大径、TNM分期、BCLC分期均是肝癌患者术后预后的影响因素,NLR及TNM分期对预后的预测价值高。

Objective To investigate the related factors affecting postoperative survival of patients with hepatocellular carcinoma(HCC)and provide guidance for clinical decision-making.Method The clinical data of 136 patients with HCC who underwent hepatectomy were collected.All patients were followed up by telephone and clinic to understand the situation of survival.Univariate analysis of factors affecting postoperative survival was performed.Result Among the 136 patients,72 were recurred and 46 were died.The median recurrence-free survival(RFS)was 32(1.2-78.0)months,and the median overall survival(OS)was 38(1.6-79.6)months.There were significant differences of median RFS among the patients with peripheral blood AST,albumin,NLR,alpha-fetoprotein(AFP),tumor maximum diameter,TNM stage,BCLC stage and presence or absence of tumor thrombus(P<0.05).There were significant differences of median OS among the patients with peripheral blood AST,albumin,NLR,tumor maximum diameter,TNM stage,BCLC stage and presence or absence of tumor thrombus(P<0.05).Multivariate Cox regression analysis showed that preoperative peripheral serum NLR,TNM stage and BCLC stage were independent factors for predicting postoperative RFS of patients with HCC(P<0.05).Albumin,NLR,the maximum diameter of the tumor and TNM stage were independent factors for predicting postoperative OS of patients with HCC(P<0.05).Conclusion Preoperative peripheral albumin,NLR,the maximum diameter of the tumor,TNM stage and BCLC stage are risk factors for postoperative prognosis of patients with HCC.The predictive value of NLR and TNM stage is high.