Naples预后评分对肝细胞癌患者肝切除术后预后的影响

Effect of Naples prognostic score on prognosis of hepatocellular carcinoma patients undergoing hepatectomy

目的分析术前Naples预后评分对肝细胞癌患者肝切除术后预后的影响。方法回顾分析2012年1月至2017年12月浙江省人民医院行根治性肝切除的323例肝细胞癌患者资料,其中男性281例,女性42例,年龄(56.6±11.3)岁。所有患者根据术前Naples预后评分分为三组:A组(0分,n=37)、B组(1~2分,n=193)、C组(3~4分,n=93)。Kaplan-Meier法分析生存情况,生存率比较采用log-rank检验。单因素和多因素Cox回归分析Naples预后评分对预后的影响。结果A组肝细胞癌患者肝切除术后1、3、5年累积生存率分别为91.9%、78.4%、68.3%,B组分别为89.1%、76.1%、64.4%,C组分别为84.9%、63.3%、43.5%,三组间累积生存率呈下降趋势,差异均有统计学意义(均P<0.05)。A组肝切除术后1、3、5年无复发生存率分别为93.4%、63.3%、44.3%,B组分别为77.7%、46.5%、35.6%,C组分别为64.1%、41.1%、28.2%,三组间无复发生存率呈下降趋势,差异均有统计学意义(均P<0.05)。多因素Cox回归分析,Naples预后评分3~4分的肝细胞癌患者肝切除术后死亡风险高于0分的肝细胞癌患者(HR=2.011,95%CI:1.048~3.859,P=0.036),术后复发风险高于0分的肝细胞癌患者(HR=1.820,95%CI:1.081~3.066,P=0.024)。结论术前Naples预后评分是肝细胞癌患者肝切除术后生存和无复发生存预后的影响因素。

Objective To assess the impact of preoperative Naples prognostic score on the prognosis of patients with hepatocellular carcinoma(HCC)after hepatic resection.Methods Retrospective analysis was conducted on the data of 323 patients with HCC who underwent radical hepatectomy in Zhejiang Provincial People's Hospital from January 2012 to December 2017,including 281 males and 42 females,aged(56.6±11.3)years.All patients were divided into three groups according to their preoperative Naples prognostic scores:group A(0)(n=37),group B(1-2)(n=193),group C(3-4)(n=93).Survival was analysed by the Kaplan-Meier method,and differences in survival were compared by the log-rank test.Univariate and multivariate Cox regression were used to analyse the effect of Naples prognostic score on prognosis.Results The 1-,3-and 5-year cumulative survival rates of HCC patients after hepatectomy were 91.9%,78.4%and 68.3%in the A group,89.1%,76.1%and 64.4%in the B group,and 84.9%,63.3%and 43.5%in the C group,respectively,and the cumulative survival rates showed a decreasing trend among the three groups,and the differences were statistically significant(all P<0.05).The recurrence-free survival rates at 1,3 and 5 years after hepatectomy were 93.4%,63.3%and 44.3%in the A group,77.7%,46.5%and 35.6%in the B group,and 64.1%,41.1%and 28.2%in the C group,respectively,and the recurrence-free survival rates showed a decreasing trend among the three groups,and the differences were statistically significant(all P<0.05).On Cox multivariate analysis,patients with HCC of 3-4 had a higher risk of death after hepatic resection than those patients of 0(HR=2.011,95%CI:1.048-3.859,P=0.036),and the risk of postoperative recurrence was also higher than those patients of 0(HR=1.820,95%CI:1.081-3.066,P=0.024).Conclusion Preoperative Naples prognostic score performs as a prognostic influence factor on survival and recurrence-free survival after hepatectomy in patients with HCC.