巨大原发性肝细胞癌切除术后预后影响因素分析

Prognosis of huge hepatocellular carcinoma after hepatectomy

目的探讨巨大原发性肝细胞癌行肝切除术后患者预后的影响因素。方法回顾性分析2012年1月至2017年12月就诊于福建省立医院的146例行肝切除术的巨大肝细胞癌患者的临床及随访资料。结果复发的独立危险因素为中性粒细胞/淋巴细胞比值≥2.49、甲胎蛋白≥400 ng/ml、非解剖性肝切除、肿瘤破裂出血、肿瘤多发、微血管侵犯以及大血管侵犯,基于以上7个因素建立复发风险模型,低危组1、3年无复发生存率为68.5%、34.2%,中危组为23.5%、15.3%,高危组为0、0。总体生存的独立危险因素为中性粒细胞/淋巴细胞比值≥2.49、甲胎蛋白≥400 ng/ml、乙肝病毒DNA载量(HBV-DNA)≥2000 IU/ml、肿瘤多发、微血管侵犯、大血管侵犯以及肝被膜侵犯。基于以上7个因素建立预测生存模型,低危组1、3年生存率为94.7%、68.4%,中危组1、3年生存率为74%、30.1%,高危组1、3年生存率为40%、5.7%。结论巨大原发性肝细胞癌术后复发率高,中性粒细胞/淋巴细胞比值、甲胎蛋白水平、HBV-DNA水平、非解剖性肝切除、肿瘤破裂出血、肿瘤多发、微血管侵犯以及大血管侵犯是影响巨大原发性肝细胞癌预后的独立危险因素。

Objective To evaluate the risk factors on prognosis after resection of huge hepatocellular carcinoma.Methods The clinical and followup data of 146 patients undergoing radical resection at Fujian Province Hospital from Jan 2012 to Dec 2017 was analyzed retrospectively.Results Independent risk factors for tumor recurrence were neutrophil/lymphocyte ratio≥2.49,serum alpha-fetoprotein≥400 ng/ml,non-anatomical hepatectomy,ruptured huge hepatocellular carcinoma,multiple tumor and microvascular invasion and macrovascular invasion.These seven factors were used to develop a risk prediction model,in which 1-year recurrence-free rates in patients with low,middle,high risk group were 68.5%,23.5%,and 0,respectively,and 3-year recurrence-free rates were 34.2%,15.3% and 0,respectively.Independent risk factors for tumor overall survival were neutrophil/lymphocyte ratio≥2.49,serum alpha-fetoprotein≥400 ng/ml,HBV-DNA≥2000 IU/ml,multiple tumor,microvascular invasion,macrovascular invasion and hepatic capsule invasion.These seven factors were used to develop a risk prediction model,in which 1-year survival rates in patients with low,middle,high risk group were 94.7%,74% and 40%,respectively,and 3-year survival rates were 68.4%,30.1%,and 5.7%,respectively.Conclusions The recurrence rate of patients with huge hepatocellular carcinoma is high.Independent risk factors affecting prognosis were high neutrophil/lymphocyte ratio,high AFP level,high HBV-DNA,non-anatomical hepatectomy,ruptured,multiple tumor,microvascular and macrovascular invasion.