不同中国肝癌分期患者根治性切除术后的复发及生存因素分析

The analysis of recurrence and survival factors in Chinese patients with different stages of liver cancer after curative resection

目的探讨不同中国肝癌分期(CNLC)患者根治性切除术后的复发及生存情况,分析影响肝细胞癌(HCC)患者术后复发、生存的危险因素。方法回顾性分析2009年10月至2010年8月行肝癌根治术的724例HCC患者的临床资料。分析患者的术前、术中及术后情况,根据CNLC进行分期,门诊及电话结合的方式进行随访。结果724例患者中,CNLC Ⅰa期383例,CNLC Ⅰb期183例,CNLCⅡa期90例,CNLCⅡb期6例,CNLCⅢa期58例,CNLCⅢb期4例。CNLCⅠa期HCC患者的复发主要为晚期复发(≥2年),占67.6%,而CNLCⅠb、CNLCⅡa、CNLCⅡb、CNLCⅢa、CNLCⅢb期HCC患者主要为早期复发,分别为48.1%、63.3%、83.3%、81%、75.0%。CNLCⅠa期患者1、3、5、10年总生存率分别为98.0%、88.9%、78.7%、58.8%;CNLCⅠb期患者1、3、5、10年总生存率分别为96.1%、78.6%、64.3%、42.9%;CNLCⅡa、Ⅱb、Ⅲa和Ⅲb期患者生存率相似。多因素分析结果显示,术前血清HBsAg水平、γ-GT水平、PT水平、肿瘤个数、肿瘤最大径、门静脉侵犯是HCC患者术后复发的独立影响因素(P<0.05)。多因素分析结果显示,年龄、术前γ-GT水平、肿瘤最大径、微血管侵犯是HCC患者术后总生存时间的独立影响因素(P<0.05)。结论不同CNLC的HCC患者术后复发及生存预后不同。

Objective To investigate recurrence and survival of hepatocellular carcinoma(HCC)patients following curative resection with different China Liver Cancer Staging(CNLC)and to analyze the risk factors for postoperative recurrence and survival.Methods Retrospectively analyze the clinical data of 724 HCC patients in Eastern Hepatobiliary Surgery Hospital underwent curative resection from October 2009 to August 2018.The preoperative,intraoperative and postoperative conditions of the patients were analyzed.The tumor were staged according to CNLC.The patients were followed up by telephone and outpatient service.Results The tumor stage among the 724 patients was as follows:CNLCⅠa,383(52.9%);CNLCⅠb,l83(25.3%);CN LCⅡa,90(12.4%);CNLCⅡb,6(0.8%);CNLCⅢa,58(8.1%);CNLCⅢb,4(0.5%).The recurrence pattern of HCC patients with CNLCⅠa was mainly late recurrence(≥2 years)and cumulative incidence of HCC recurrence≥2 years was 67.6%,while HCC patients with CNLCⅠb,CNLCⅡa,CNLCⅡb,CNLCⅢa and CNLCⅢb were mainly early recurrence and cumulative incidence of HCC recurrence<2 years was 48.1%,63.3%,83.3%,81%and 75.0%,respectively.The 1-,3-,5-,10-years overall survival(OS)for CNLCⅠa was 98.0%、88.9%、78.7%、58.8%;the 1-,3-,5-,10-years OS for CNLCⅠb was 96.1%、78.6%、64.3%、42.9%,The survival rates of patients with CNLCⅡa,CNLCⅡb,CNLCⅢa and CNLCⅢb were similar.The multivariate analysis revealed that HBsAg level,γ-GT level,PT level,tumor number,tumor length,portal vein invasion were independent influencing factors affecting postoperative recurrence of HCC patients following curative resection.The multivariate analysis revealed that Age,γ-GT level,tumor length,microvascular invasion were independent influencing factors affecting cumulative survival time of HCC following curative resection(P<0.05).Conclusions HCC patients with different stages of CNLC have different postoperative recurrence patterns and prognosis.