肝癌患者肝切除术后的预后危险因素分析:一项单中心研究

Analysis of risk factors affecting the postoperative prognosis of patients with hepatocellular carci⁃noma:a single⁃center analysis

目的探讨影响肝癌患者肝切除术后的预后的独立危险因素。方法回顾性分析2017年6月1日至2022年1月1日在中山市人民医院进行肝切除术的211例肝癌患者。采用Cox回归分析进行单因素和多因素分析,确定影响无瘤生存期和总生存期的独立危险因素。采用Kaplan⁃meier生存分析来评估独立危险因素的无瘤生存率和总生存率。结果根据多因素分析,甲胎蛋白(HR=1.000;95%CI:1.000~1.000;P=0.024)、异常凝血酶原(HR=1.000;95%CI:1.000~1.000;P=0.045)、肿瘤直径(HR=1.007;95%CI:1.001~1.015;P=0.008)、门脉癌栓(HR=2.590;95%CI:1.215~4.132;P=0.023)、微血管侵犯(HR=2.290;95%CI:1.282~4.161;P=0.001)、卫星结节(HR=2.185;95%CI:1.177~4.056;P=0.013)和肿瘤分化类型(中分化/高分化:HR=1.127;95%CI:0.530~2.369;P=0.755;低分化/高分化:HR=2.468;95%CI:1.104~5.372;P=0.019)是影响患者无瘤生存期的危险因素,而肿瘤直径(HR=1.011;95%CI:1.003~1.017;P=0.031)、肝硬化(HR=2.113;95%CI:1.057~3.233;P=0.043)、微血管侵犯(HR=2.159;95%CI:1.531~5.238;P=0.029)、卫星结节(HR=2.778;95%CI:1.144~6.744;P=0.024)和肿瘤分化类型(中分化/高分化:HR=1.896;95%CI:0.368~9.769;P=0.444;低分化/高分化:HR=3.760;95%CI:1.745~8.989;P=0.024)是影响患者总生存期的危险因素。CNLC I期的1年、2年和3年的累积无瘤生存率(81.0%~70.9%~66.9%vs.61.8%~43.3%~30.3%,P<0.001)和累积总生存率(95.3%~89.5%~87.5%vs.87.6%~57.6%~57.6%,P<0.001)均明显高于CNLCⅡ⁃Ⅲa期(中位无瘤生存期17个月)。结论甲胎蛋白、异常凝血酶原、门脉癌栓、肿瘤直径、肝硬化、微血管侵犯、卫星结节和肿瘤分化类型可能是影响患者预后的独立危险因素,而CNLC分期能更好地评估患者的复发与生存。

Objective To investigate the independent risk factors affecting the postoperative prognosis of patients with hepatocellular carcinoma.Methods A retrospective analysis was conducted on 211 patients with hepatocellular carcinoma who underwent hepatectomy at Zhongshan People′s Hospital from June 1,2017,to January 1,2022.Cox regression analysis was used for univariate and multivariate analysis to determine the independent risk factors influencing diseasefree survival and overall survival.Kaplan⁃Meier survival analysis was employed to evaluate the disease⁃free survival rate and overall survival rate associated with independent risk factors.Results According to multivariate analysis,alpha⁃fetoprotein(HR=1.000;95%CI:1.000-1.000;P=0.024),abnormal prothrombin(HR=1.000;95%CI:1.000-1.000;P=0.045),tumor diameter(HR=1.007;95%CI:1.001-1.015;P=0.008),portal vein tumor thrombus(HR=2.590;95%CI:1.215-4.132;P=0.023),microvascular invasion(HR=2.290;95%CI:1.282-4.161;P=0.001),satellite nodules(HR=2.185;95%CI:1.177-4.056;P=0.013),and tumor differentiation type(Medium/high differentiation:HR=1.127;95%CI:0.530-2.369;P=0.755;low/high differentiation:HR=2.468;95%CI:1.104-5.372;P=0.019)were identified as risk factors influencing patients′disease⁃free survival.Tumor diameter(HR=1.011;95%CI:1.003-1.017;P=0.031),liver cirrhosis(HR=2.113;95%CI:1.057-3.233;P=0.043),microvascular invasion(HR=2.159;95%CI:1.531-5.238;P=0.029),satellite nodules(HR=2.778;95%CI:1.144-6.744;P=0.024),and tumor differentiation type(Medium/high differentiation:HR=1.896;95%CI:0.368-9.769;P=0.444;Low/high differentiation:HR=3.760;95%CI:1.745-8.989;P=0.024)were found to be risk factors affecting patients′overall survival.The cumulative disease⁃free survival rates at 1 year,2 years,and 3 years for CNLC stage I were significantly higher compared to CNLC stagesⅡ⁃Ⅲa(81.0%-70.9%-66.9%vs.61.8%-43.3%-30.3%,P<0.001).Similarly,the cumulative overall survival rates at 1 year,2 years,and 3 years for CNLC stage I were also significantly higher than those for CNLC stagesⅡ⁃Ⅲa(95.3%-89.5%-87.5%vs.87.6%-57.6%-57.6%,P<0.001,Median disease⁃free survival of 17 months).Conclusions Alpha⁃fetoprotein,abnormal prothrombin,portal vein tumor thrombus,tumor diameter,liver cirrhosis,microvascular invasion,satellite nodules,and tumor differentiation type are potential independent risk factors influencing patients′prognosis.Furthermore,CNLC staging can better evaluate patients′recurrence and survival outcomes.