隐匿型破裂的肝细胞癌患者肝切除术后预后影响因素分析

Prognostic factors in patients with occult ruptured hepatocellular carcinoma after hepatectomy

目的分析隐匿型破裂的肝细胞癌患者肝切除术后预后的影响因素。方法回顾性分析2001年1月至2014年12月连续在菏泽市立医院行肝切除的31例隐匿型破裂的肝细胞癌患者临床资料,其中男性27例,女性4例,年龄29~73岁。术后均进行随访。采用Kaplan-Meier法进行生存分析,比较采用log-rank检验。多因素分析采用Cox比例风险模型。结果所有患者均获得随访,31例患者中死亡27例(87.1%),术后复发转移25例(80.6%)。31例患者中位总体生存时间8个月,中位无瘤生存时间4个月。多因素分析显示,非R0切除是隐匿型破裂的肝细胞癌患者无瘤生存(RR=3.295,95%CI:1.215~8.940)、总体生存(RR=2.816,95%CI:1.006~7.887)的独立危险因素,肝癌低分化(RR=3.120,95%CI:1.193~8.160)也是总体生存的独立危险因素。结论非R0切除的隐匿型破裂的肝细胞癌患者肝切除术后预后较差,肝癌组织低分化的隐匿型破裂的肝细胞癌患者肝切除术后总体生存较差。

Objective To study the prognostic factors in patients with occult ruptured hepatocellular carcinoma(HCC)after hepatectomy.Methods The clinical data of 31 patients with occult ruptured HCC who underwent hepatectomy at the Heze Multiple Hospital from January 2001 to December 2014 were retrospectively analyzed.There were 27 males and 4 females,with ages ranging from 29 to 73 years.Kaplan-Meier survival analysis was carried out for survival analysis,and compared by the log-rank test.Multivariate analysis was conducted using the Cox proportional hazards regression model.Results Of 31 patients in this study,27(87.1%)had died,and 25(80.6%)had developed tumor recurrence and metastasis.The median overall survival was 8 months and the median tumor-free survival was 4 months.On Cox regression analysis,non-R0 resection was an independent risk factor of overall survival(RR=2.816,95%CI:1.006-7.887)and disease-free survival(RR=3.295,95%CI:1.215-8.940).Poor tumor differentiation was an independent risk factor of overall survival(RR=3.120,95%CI:1.193-8.160).Conclusions The prognosis of patients with occult rupture HCC who underwent no R0 resection was poor.However,the prognosis of patients who underwent non-R0 resection was even poorer.