老年可切除肝癌伴门静脉癌栓预后的影响因素分析

Prognostic factors of resectable hepatocellular carcinoma with portal venous thromboembolism in the elderly

[目的]分析老年可切除肝癌伴门静脉癌栓预后的影响因素。[方法]入选对象254例,均为接受了肝癌根治性切除+门静脉切开取栓、门静脉癌切除、右半肝或左半肝切除的老年患者,治疗完毕后均进行了随访,每半年随访1次,汇总收集的资料中涉及到多项内容[性别、分化程度、肿瘤直径、癌栓分型、合并肝硬化、甲胎蛋白、术后肝动脉化疗栓塞术(TACE)、肝内转移、癌栓类型]。[结果]随访结束后,生存患者共84例(生存组),死亡患者共170例(死亡组)。2组性别、分化程度、癌栓类型、甲胎蛋白比较差异无统计学意义(P>0.05);与生存组比较,死亡组低分化、肿瘤直径≥8 cm、患有肝硬化的例数均超过生存组,并且手术完成后,行TACE例数、出现肝内转移、浸润癌栓类型均超过生存组(P<0.05)。将单因素分析中差异有统计学的指标归入多因素分析,表明低分化、肿瘤直径≥8 cm、术后TACE、肝内转移、浸润型癌栓是影响预后的主要因素。[结论]影响老年可切除肝癌伴门静脉癌栓预后的主要因素是分化程度、肿瘤直径、术后TACE、肝内转移和癌栓类型。

[Objective]To analyze the prognostic factors of resectable hepatocellular carcinoma with portal venous thromboembolism in the elderly.[Methods]The subjects were elderly patients with resectable hepatocellular carcinoma accompanied by portal venous thromboembolism.A total of 254 patients were diagnosed and treated in our hospital from October 2015 to October 2019.All of them had undergone radical resection of liver cancer plus portal vein incision for thrombotomy, portal venous carcinoma resection, right or left liver resection.After completion of treatment, every patient was followed up.Every six months, the patient was asked about all aspects by telephone, and the survival status of the patient was also known by outpatient service.The final follow-up time was October 2020.The collected data involved a number of contents, including gender, degree of differentiation, tumor diameter, type of cancer thrombi, complicated liver cirrhosis, alpha-fetoprotein, postoperative TACE,intrahepatic metastasis, and type of cancer thrombi.[Results]At the end of follow-up, 84 patients survived and 170 died.There were no statistically significant differences in gender, degree of differentiation, type of cancer plug and alpha-fetoprotein between the two groups(P> 0.05).The number of tumor diameter greater than or equal to 8 cm in death group was more than the survival group, at the same time, the number of patients with liver cirrhosis was more than the survival group.After the completion of the operation, the number of intrahepatic metastasis in death group was more than the survival group, and infiltrating carcinoma bolt type was more(P< 0.05).The indicators showing statistical differences in univariate analysis could be classified into multi-factor analysis, and the main influencing factors were identified, such as low differentiation, direct tumor size greater than or equal to 8 cm, postoperative TACE,intrahepatic metastasis, and invasive tumor thrombi.[Conclusion]A variety of factors can affect the prognosis of resectable hepatocellular carcinoma with portal venous thromboembolism in the elderly.The main factors are differentiation degree, tumor diameter, postoperative TACE,intrahepatic metastasis and type of tumor thromboembolism.