原发性肝细胞癌合并门静脉癌栓手术治疗的预后相关因素分析

Prognostic factors of primary hepatocellular carcinoma complicated with portal vein tumor thrombus after surgical treatment

目的探讨影响手术切除原发性肝细胞癌(HCC)合并门静脉癌栓(PVTT)患者预后的相关性因素。方法回顾性分析2015年1月至2018年1月150例行手术切除治疗的HCC合并PVTT患者临床资料,采用SPSS21.0统计软件进行数据分析。用Kaplan-Meier法计算总生存率及绘制生存曲线,用Log-Rank检验对各个可能影响预后的因素进行分析。以P<0.05为差异有统计学意义。结果患者中位生存时间为14个月,其中术后1年、2年和3年生存率分别为62.3%、34.8%、21.7%。术前血清甲胎蛋白(AFP)浓度、肿瘤大小、肿瘤包膜、卫星灶、微血管侵犯、PVTT类型、术后病理分级均为影响患者预后的因素。结论对于术前血清AFP≥400μg/L,肿瘤直径≥5cm,肿瘤无包膜、有卫星灶及有微血管侵犯的患者术后生存率相对较低。当门静脉癌栓累及到主干时,手术治疗效果并不令人满意。

Objective To investigate the prognostic factors of patients with surgically resected primary liver cancer(HCC)complicated with portal vein tumor thrombus(PVTT).Methods The clinical data of 150 patients with HCC complicated with PVTT who underwent surgical resection from January 2015 to January 2018 were retrospectively analyzed.SPSS 21.0 statistical software was used for data analysis.Kaplan-Meier method was used to calculate the overall survival rate and draw the survival curve.Log-Rank test was used to analyze the prognostic factors.P<0.05 was considered statistically significant.Results The median survival time was 14 months,and the 1,2 and 3-year survival rates were 62.3%,34.8%and 21.7%,respectively.Preoperative serum AFP concentration,tumor size,tumor capsule,satellite lesion,microvascular invasion,PVTT type and postoperative pathological grade were all factors affecting the prognosis of patients.Conclusions The survival rate of patients with preoperative serum AFP≥400μg/L,tumor diameter≥5 cm,tumor without capsule,satellite lesion and microvascular invasion is relatively low.When portal vein tumor thrombus is involved in the main trunk,surgical treatment is not satisfactory.