乙肝病毒感染对胰腺癌患者根治术后肝转移的影响

Effect of HBV infection on liver metastasis of pancreatic cancer patients after radical operation

目的:探讨乙肝病毒(HBV)感染对胰腺癌患者根治术后肝转移的影响。方法:回顾性分析2013年1月-2015年12月接受胰腺癌根治术的156例患者的临床病理资料,采用Kaplan-Meier单因素分析比较各临床病理因素分组胰腺癌术后无肝转移生存率、Cox单因素和多因素分析获得影响胰腺癌患者根治术后肝转移的独立预测因素,Kaplan-Meier生存分析比较HBV和N-HBV2组患者胰腺癌术后无肝转移生存率。结果:156例接受胰腺癌根治术患者,其中男105例(67.3%),女51例(32.7%),平均年龄为(53.8±10.9)岁,胰腺癌根治术后1年、2年、3年肝转移发生率分别为33.5%、48.9%和56.3%,Cox多因素分析结果显示,TNM/T分期、血管神经侵犯、HBV感染以及HBV-DNA为影响胰腺癌患者根治术后肝转移的独立预测因素,其中TNM/T_(2)+T_(3)分期胰腺癌术后肝转移的风险是TNM/T分期的4.654倍(HR:4.654,95%CI:3.876~5.432,P=0.000),伴有血管神经侵犯患者胰腺癌术后肝转移的风险是无血管神经侵犯的4.215倍(HR:4.215,95%CI:3.245~5.125,P=0.011),HBV感染患者胰腺癌术后肝转移的风险是非HBV感染患者的2.817倍(HR:2.817,95%CI:2.135~3.568,P=0.026),Kaplan-Meier生存分析显示,N-HBV组胰腺癌术后1年、2年、3年的无肝转移生存率明显高于HBV组(73.6%、57.4%、43.1%vs.61.5%、38.4%、30.4%,P<0.05)。结论:胰腺癌术后肝转移与TNM/T分期、肿瘤血管神经侵犯及伴有HBV感染密切相关。

Objective: To investigate the effect of HBV infection on liver metastasis of pancreatic cancer patients after radical operation. Methods: The clinicopathological data of 156 patients with pancreatic cancer who underwent radical surgery from January 2013 to December 2015 were retrospectively analyzed. Kaplan-Meier univariate analysis was used to compare the liver metastasis free survival rate of post operative pancreatic cancer patients between different clinicopathological factor group. Cox univariate analysis and multivariate analysis were used to obtain independent predictors of infecting liver metastasis of pancreatic cancer patients after radical surgery, Kaplan-Meier survival analysis was used to compare the liver metastasis free survival rates of postoperative patients between HBV infection and N-HBV infection. Results: 156 patients with pancreatic cancer underwent radical operation, the average age was(53.8±10.9), among them, 105(67.3%) were male and 51(32.7%) were female. The 1-year, 2-year, and 3-year liver metastasis rates were 33.5%, 48.9%, and 56.3%, respectively. The results of Cox multivariate analysis showed that TNM/T stage, vascular nerve invasion and HBV infection were independent predictors of infecting postoperative liver metastasis of pancreatic cancer patients. The risk of postoperative liver metastasis in TNM/T_(2)+T_(3) stage was 4.654 times higher than that in TNM/T;stage(HR: 4.654, 95%CI: 3.876-5.432, P=0.000), the risk of postoperative liver metastasis in patients with vascular and nerve invasion was 4.215 times higher than that in patients without vascular and nerve invasion(HR: 4.215, 95%CI: 3.245-5.125, P=0.011). The risk of postoperative liver metastasis in patients with HBV infection was 2.817 times higher than that in patients without HBV infection(HR: 2.817, 95%CI: 2.135-3.568, P=0.026). Kaplan-Meier survival analysis showed that the 1-year, 2-year, 3-year liver metastasis free survival rate of postoperative N-HBV infection group was significantly higher than that in HBV infection group(73.6%, 57.4%, 43.1% vs. 61.5%, 38.4%, 30.4%, P<0.05). Conclusion: Postoperative liver metastasis of pancreatic cancer is closely related to TNM/T stage, tumor vascular and nerve invasion and HBV infection.