癌旁肝星状细胞和γδT淋巴细胞比值与肝细胞癌根治性肝切除术后预后的关系研究

Prognostic relationship between ratio of peritumoral hepatic steDate cells to γδ T cells and prognosis of patients with hepatocellular carcinoma after curative resection

目的分析肝细胞癌患者癌旁组织肝星状细胞与γδT淋巴细胞比值与根治性切除术后预后的关系。方法回顾分析重庆医科大学附属第一医院肝胆外科2011年1月至2013年12月连续接受根治性肝切除的320例肝细胞癌患者资料,其中男性273例,女性47例,年龄17-80岁,中位年龄53岁。癌旁肝组织标本行免疫组化染色,计算肝星状细胞与HT淋巴细胞比值。Kaplan-Meier法进行生存分析。肝细胞癌患者预后单因素分析采用log-rank检验,多因素分析采用Cox回归分析。结果多因素分析,肿瘤多发(HR=1.895,95%CZ:1.155~3.108)、微血管侵犯(HR=1.665,95%C/:1.104-2.512)、肿瘤直径>5 cm(HR=2.400,95%CI:1.603-3.594)、肝星状细胞与γδT淋巴细胞比值>18(HR=1.880,95%CI:1.257-2.810)是肝细胞癌患者根治性肝切除术后生存的独立危险因素。术前甲胎蛋白>20 μg/L(HR=1.631,95%CZ:1.151-2.311),微血管侵犯(HR=2.145,95%CI:1.536~2.994)、肿瘤直径>5 cm(HR=1.866,95%CI:l.342~2.592)、肝星状细胞与疋丁淋巴细胞比值>18(HR=1.517,95%CI:1.084-2.122)是肝细胞癌患者无瘤生存的独立危险因素。根据癌旁组织肝星状细胞与78T淋巴细胞比值将患者分为低比值组(比值≤18,n=222)和高比值组(比值〉18=98)。低比值组患者累积生存率和累积无瘤生存率均优于高比值组,差异有统计学意义(均P<0.05)。结论癌旁肝星状细胞与γδT淋巴细胞比值是肝细胞癌患者根治性肝切除术预后的影响因素,低比值患者预后更佳。

Objective To study the association between ratio of peritumoral hepatic stellate cells to γδ cells ratio(SGR)and prognosis of patients with hepatocellular carcinoma(HCC)after curative resection.Methods From January 2011 to December 2013,the clinical data of 320 patients with HCC who underwent curative resection at the Department of Hepatobiliary Surgery,the First Affiliated Hospital of Chongqing Medical University were collected and analyzed retrospectively.Immunohistochemistry was used to calculate the SGR in adjacent cancer tissues.Survival was estimated by Kaplan-Meier method.Prognosis of HCC patients was analyzed by univariate and multivariate analyses.Results Multivariate analysis revealed multiple tumors(HR=1.895,95%CI:1.155-3.108),microvascular invasion(HR=1.665,95%CI:1.104-2.512),tumor size>5 cm(HR=2.400,95%CI:1.603-3.594)and peritumoral SGR>18(HR=1.880,95%CI-1.257-2.810)were independent risk factors of the overall survival rate in HCC patients.Preoperative AFP>20 jjig/L(HR=1.631,95%CZ:1.151-2.311),microvascular invasion(HR=2.145,95%CI:1.536-2.994),tumor size>5 cm(HR=1.866,95%CI:1.342-2.592)and peritumoral SGR>18{HR=1.517,95%CZ:1.084-2.122)were independent risk factors of the tumor-firee survival rate in HCC patients.Patients were then divided into the low SGR(ratio W18,n=222)and high SGR groups(ratio>18,n=98)using SGR in adjacent cancer tissues.The overall survival and tumor-free survival rates of the low SGR group were significantly better than the high SGR group(P<0.05).Conclusion Peritumoral SGR was an independent prognostic factor of patients with HCC following radical resection.The prognosis of patients with low SGR was better.