肝癌患者单纯全尾状叶切除术预后的影响因素

Cox regression analysis of the factors affecting the prognosis of liver cancer patients after total caudate lobectomy

目的探究肝癌患者行单纯全尾状叶切除术预后的影响因素。方法选择2019年7月至2020年7月在廊坊市人民医院行全尾状叶切除术的肝癌患者200例,随访时间为2020年7月至2021年7月。收集所有患者的临床特征,包括:年龄、肿瘤直径、肿瘤TNM分期、肿瘤包膜、肿瘤位置、肝内转移、血液转移、门脉癌栓、肝功能Child-Pugh分级、吸烟、饮酒、抗病毒治疗、甲胎蛋白、胆红素、AST、表皮生长因子受体表达情况。采用单因素分析及多因素Cox回归分析肝癌患者行单纯全尾状叶切除术后预后的影响因素。结果肿瘤直径≥5 cm、未出现肿瘤包膜、肿瘤位置在左边、出现肝内转移与血液转移、存在门脉癌栓、未进行抗病毒治疗、甲胎蛋白≥400 ng/L、胆红素≥34.2μmol/L、AST≥80 U/L的患者生存率较低。随访1年,结果显示患者生存时间为(9.50±2.31)个月,总生存率为54.50%(109/200)。多因素Cox回归分析结果显示,存在门脉癌栓、甲胎蛋白≥400 ng/L是预后的危险因素(P<0.05)。结论肝癌患者行单纯全尾状叶切除术后1年生存率较低,出现门脉癌栓与甲胎蛋白表达量异常升高是影响患者预后情况的危险因素,临床需针对出现以上情况的患者进行重点监测与对症诊治。

Objective To explore the prognosis of liver cancer patients undergoing pure caudate lobectomy,and analyze the risk factors that affect the prognosis via multivariate COX regression models.Methods 200 patients with liver cancer who underwent total caudate lobectomy in our hospital from July 2019 to July 2020 were selected for clinical and follow-up studies.The follow-up period was from July 2020 to July 2021.The clinical characteristics of all patients were collected,including age,tumor diameter,tumor TNM stage,tumor envelope,tumor location,intrahepatic metastasis,blood metastasis,portal vein cancer thrombus,liver function Child-Pugh classification,smoking,drinking,antiviral Treatment,levels of serum alpha-fetoprotein,bilirubin,aspartate aminotransferase,and the expression of epidermal growth factor receptor.Univariate analysis and multivariate COX regression were used to analyze the factors affecting the prognosis of liver cancer patients after isolated caudate lobectomy.Results Tumor diameter≥5 cm,without tumor envelope,tumor located at the left lobe,with intrahepatic metastasis and blood metastasis,with cancer-associated potal thrombus,without antiviral therapy,alpha-fetoprotein≥400 ng/L,bilirubin≥34.2μmol,aspartate aminotransferase≥80 U/L,and aspartate aminotransferase≥80 U/L were associated with a lower survival rate.The 1 year,follow-up results showed that the average survival time of patients was(9.50±2.31)months,and the overall survival rate of 200 patients was 54.50%;multivariate COX regression analysis showed that the presence of cancer-associated thrombus in portal vein and alpha-fetoprotein≥400 ng/L were prognostic risk factors(P<0.05).Conclusion The 1-year survival rate of patients with liver cancer undergoing isolated caudate lobectomy is low.Among them,the presence of portal vein tumor thrombus and abnormally increased expression of alpha-fetoprotein are risk factors that affect the patients’prognosis.It is therefore necessary to address the aboval conditions,effectively monitor and treat the patients for achieving a better prognosis.