多发性肝癌肝切除术患者远期预后的影响因素分析

Influencing factors of long-term prognosis in patients with multiple hepatocellular carcinomas undergoing hepatectomy

目的探讨多发性肝癌肝切除术患者远期预后的影响因素。方法纳入多发性肝癌患者102例开展回顾性研究,均行肝切除术,记录并计算患者的中位生存时间、总生存期以及1、2、4年的累积生存率。经多元Cox回归模型分析患者远期预后的影响因素。结果102例患者的中位生存时间为42个月,总生存期为32个月,1、2、4年的累积生存率分别为79.57%、64.52%和44.09%。多元Cox回归分析提示临床分期Ⅲa期、肿瘤最大直径>5 cm、病灶数量≥4个、门脉瘤栓、微血管侵犯是多发性肝癌患者预后的独立危险因素(P<0.05),而肿瘤包膜完整、术后辅助治疗是术后生存的保护性因素(P<0.05)。结论多发性肝癌行肝切除术后远期疗效仍不够理想,患者远期预后主要与临床分期、肿瘤大小、病灶数量、门脉瘤栓、肿瘤包膜是否完整、微血管侵犯、术后辅助治疗有关。

Aim To investigate the influencing factors of long-term prognosis in patients with multiple liver cancer who underwent liver resection.Methods A retrospective study was conducted on 102 patients with multiple liver cancer.All of them underwent hepatectomy and were followed up for 12-48 months.Median survival time,overall survival time,and 1,2,and 4 years'cumulative survival rate were recorded and calculated.Multivariate Cox regression model was used to analyze the influencing factors of long-term prognosis.Results The median survival time of 102 patients was 42 months,and the overall survival time was 32 months.The cumulative survival rates of 1,2,and 4 years were 79.57%,64.52%,and 44.09%,respectively.Multivariate Cox regression analysis showed that clinical stageⅢa,the largest tumor diameter>5 cm,the number of lesions≥4,portal aneurysm thrombus,and microvascular invasion were independent risk factors for the prognosis of patients with multiple liver cancer(P<0.05),whereas postoperative adjuvant therapy was a protective factor for postoperative survival(P<0.05).Conclusion The long-term efficacy of multiple liver cancer after hepatectomy is still not ideal.The long-term prognosis of patients is mainly related to clinical stage,tumor size,number of lesions,portal vein tumor thrombus,tumor capsule integrity,microvascular invasion,and postoperative adjuvant therapy.