影响肝癌根治术预后的临床研究

Clinical Evaluation of Prognosis after Radical Operation on Liver Cancer

本文运用Cox模型,对115例肝癌根治术后的13项因子进行多因素分析。筛选出肝硬化、肿瘤包膜、瘤栓及AFP转归等四项指标是影响预后的重要因素,肿瘤大小接近显著临界值,对上述各项指标及肝癌复发时的AFP变化规律等逐项进行临床资料分析,提出了防治肝癌复发的措施;术后AFP是否转阴性,是影响预后的决定性因素,二者术后1、5及10年生存率分别为97.5％与38.9％、77.1％与0、62.2％与0;小肝癌的外科治疗,是治愈肝癌的关键,5、10年生存率分别为61.8％、48.1％;术后防治肝炎、肝硬化、增强机体免疫治疗及适当化疗,预计可提高远期生存率。

Cox regression model was applied to the multivariate analysis of 115 patients with liver cancer after radical opera- tion. Among 13 factors, cirrhosis, tumor encapsulation, thrombus in vessel, subsequent AFP determinations were the most important factors that influence prognosis postoperatively. The role of tumor size in governing the prognosis was up to the statistically significant level. In light of the analysis on dynamic AFP level when recurrence of liver cancer occurs pro- phylactic measures against recurrence of liver cancer were discussed. Whether AFP turned to be negative seemed to be the decisive factor affecting prognosis of liver cancer. The 1-,5-, and 10-year survival rates in patients with negative AFP after operation were 97.5%, 77.1% ,and 62.2%, while those in patients whose AFP remained positive were 38.9%, 0% and 0% respectively. The 5-, 10-year survival rates in patients with small liver cancer were 61.8% and 48.1% re- spectively. Ultimate outcome could be improved by controlling hepatitis and cirrhosis, and giving immunotherapy and chemotherapy.