中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2011年
4期
263-266
,共4页
肝肿瘤%肝切除术%复发%危险因素
肝腫瘤%肝切除術%複髮%危險因素
간종류%간절제술%복발%위험인소
Liver neoplasms%Hepatectomy%Recurrence%Risk factors
目的 探讨原发性肝细胞癌(HCC)根治术后患者肿瘤早、晚期复发的影响因素及预后.方法 回顾性分析2003年1月至2006年12月华中科技大学附属同济医院收治的117例行HCC根治术患者的临床资料,以术后2年为界,≤2年肿瘤复发为早期复发,＞2年为晚期复发.分析AFP、AFP/肿瘤单位体积(AFP/V)、肿瘤直径、肿瘤数目、血管侵犯、肿瘤分化程度、肝硬化程度、肝功能分级、HBsAg、肝切除方式、术中输血等因素与术后肿瘤复发的关系,采用Kaplan-Meier生存分析法计算患者术后总体生存率和无瘤生存率,Log-rank法对生存率进行检验.结果 117例患者中有85例(72.6%)出现肿瘤复发,其中早期复发59例(50.4%)、晚期复发26例(22.2%).AFP、AFP/V、肿瘤直径、肿瘤数目、血管侵犯、肿瘤分化程度、术中输血是术后肿瘤早期复发的影响因素(x2=12.78,13.40,5.79,9.98,10.26,9.48,8.32,P＜0.05);AFP、肝硬化程度是术后肿瘤晚期复发的影响因素(x2=4.46,7.75,P＜0.05).AFP/V、肿瘤数目、血管侵犯是术后肿瘤早期复发的独立危险因素(RR=0.170,0.172,0.064,P＜0.05);肝硬化程度是术后肿瘤晚期复发的独立危险因素(RR=2.809,P＜0.05).本组患者术后1、3、5年总体生存率和无瘤生存率分别为82.6%、60.8%、54.9%和65.0%、38.5%、23.1%.AFP＜20μg/L、AFP/V＜14 μg/(L·cm3)、AFP/V14μg/(L·cm3)的患者总体生存率和无瘤生存率比较,差异有统计学意义(P＜0.05).肿瘤早期复发患者1、3、5年总体生存率分别为64.9%、23.0%、20.5%;肿瘤晚期复发患者1、3、5年总体生存率分别为100.0%、88.5%、72.5%,两者比较,差异有统计学意义(x2=26.918,P＜0.05).结论 AFP/V、肿瘤数目、血管侵犯是肿瘤早期复发的独立危险因素,肝硬化程度是肿瘤晚期复发的独立危险因素.HCC根治术后肿瘤早、晚期复发患者生存率存在差异.
目的 探討原髮性肝細胞癌(HCC)根治術後患者腫瘤早、晚期複髮的影響因素及預後.方法 迴顧性分析2003年1月至2006年12月華中科技大學附屬同濟醫院收治的117例行HCC根治術患者的臨床資料,以術後2年為界,≤2年腫瘤複髮為早期複髮,＞2年為晚期複髮.分析AFP、AFP/腫瘤單位體積(AFP/V)、腫瘤直徑、腫瘤數目、血管侵犯、腫瘤分化程度、肝硬化程度、肝功能分級、HBsAg、肝切除方式、術中輸血等因素與術後腫瘤複髮的關繫,採用Kaplan-Meier生存分析法計算患者術後總體生存率和無瘤生存率,Log-rank法對生存率進行檢驗.結果 117例患者中有85例(72.6%)齣現腫瘤複髮,其中早期複髮59例(50.4%)、晚期複髮26例(22.2%).AFP、AFP/V、腫瘤直徑、腫瘤數目、血管侵犯、腫瘤分化程度、術中輸血是術後腫瘤早期複髮的影響因素(x2=12.78,13.40,5.79,9.98,10.26,9.48,8.32,P＜0.05);AFP、肝硬化程度是術後腫瘤晚期複髮的影響因素(x2=4.46,7.75,P＜0.05).AFP/V、腫瘤數目、血管侵犯是術後腫瘤早期複髮的獨立危險因素(RR=0.170,0.172,0.064,P＜0.05);肝硬化程度是術後腫瘤晚期複髮的獨立危險因素(RR=2.809,P＜0.05).本組患者術後1、3、5年總體生存率和無瘤生存率分彆為82.6%、60.8%、54.9%和65.0%、38.5%、23.1%.AFP＜20μg/L、AFP/V＜14 μg/(L·cm3)、AFP/V14μg/(L·cm3)的患者總體生存率和無瘤生存率比較,差異有統計學意義(P＜0.05).腫瘤早期複髮患者1、3、5年總體生存率分彆為64.9%、23.0%、20.5%;腫瘤晚期複髮患者1、3、5年總體生存率分彆為100.0%、88.5%、72.5%,兩者比較,差異有統計學意義(x2=26.918,P＜0.05).結論 AFP/V、腫瘤數目、血管侵犯是腫瘤早期複髮的獨立危險因素,肝硬化程度是腫瘤晚期複髮的獨立危險因素.HCC根治術後腫瘤早、晚期複髮患者生存率存在差異.
목적 탐토원발성간세포암(HCC)근치술후환자종류조、만기복발적영향인소급예후.방법 회고성분석2003년1월지2006년12월화중과기대학부속동제의원수치적117례행HCC근치술환자적림상자료,이술후2년위계,≤2년종류복발위조기복발,＞2년위만기복발.분석AFP、AFP/종류단위체적(AFP/V)、종류직경、종류수목、혈관침범、종류분화정도、간경화정도、간공능분급、HBsAg、간절제방식、술중수혈등인소여술후종류복발적관계,채용Kaplan-Meier생존분석법계산환자술후총체생존솔화무류생존솔,Log-rank법대생존솔진행검험.결과 117례환자중유85례(72.6%)출현종류복발,기중조기복발59례(50.4%)、만기복발26례(22.2%).AFP、AFP/V、종류직경、종류수목、혈관침범、종류분화정도、술중수혈시술후종류조기복발적영향인소(x2=12.78,13.40,5.79,9.98,10.26,9.48,8.32,P＜0.05);AFP、간경화정도시술후종류만기복발적영향인소(x2=4.46,7.75,P＜0.05).AFP/V、종류수목、혈관침범시술후종류조기복발적독립위험인소(RR=0.170,0.172,0.064,P＜0.05);간경화정도시술후종류만기복발적독립위험인소(RR=2.809,P＜0.05).본조환자술후1、3、5년총체생존솔화무류생존솔분별위82.6%、60.8%、54.9%화65.0%、38.5%、23.1%.AFP＜20μg/L、AFP/V＜14 μg/(L·cm3)、AFP/V14μg/(L·cm3)적환자총체생존솔화무류생존솔비교,차이유통계학의의(P＜0.05).종류조기복발환자1、3、5년총체생존솔분별위64.9%、23.0%、20.5%;종류만기복발환자1、3、5년총체생존솔분별위100.0%、88.5%、72.5%,량자비교,차이유통계학의의(x2=26.918,P＜0.05).결론 AFP/V、종류수목、혈관침범시종류조기복발적독립위험인소,간경화정도시종류만기복발적독립위험인소.HCC근치술후종류조、만기복발환자생존솔존재차이.
Objective To investigate the influencing factors and prognosis of early and late recurrence after radical resection of primary hepatocellular carcinoma(HCC).Methods The clinical data of 117 patients who received radical resection of HCC at the Tongji Hospital of Huazhong University of Science and Technology from January 2003 to December 2006 were retrospectively analyzed.Tumor recurrence occurred within 2 years after operation was defined as early recurrence,and tumor recurrence occurred latter than 2 years after operation was defined as late recurrence.Relationship between postoperative tumor recurrence and level of alpha-fetoprotein (AFP),AFP/V,tumor diameter,tumor number,blood vessel invasion,tumor differentiation,hepatic cirrhosis,hepatic function,hepatitis B surface antigen,procedure of hepatic resection and blood transfusion was analyzed.The overall survival and disease-free survival rates were determined by Kaplan-Meier method,and the survival rate was analyzed by Log-rank test.Results Eighty-five(72.6％)patients were found with tumor recurrence,including 59(50.4％)with early tumor recurrence and 26(22.2％)with late tumor recurrence.Levels of AFP,AFP/V,tumor diameter,tumor number,blood vessel invasion,tumor differentiation and blood transfusion were the influencing factors of early recurrence(x2 = 12.78,13.40,5.79,9.98,10.26,9.48,8.32,P ＜ 0.05).Level of AFP and hepatic cirrhosis were the influencing factors of late recurrence(x2 =4.46,7.75,P ＜ 0.05).AFP/V,tumor number and blood vessel invasion were the independent risk factors of early recurrence(RR = 0.170,0.172,0.064,P ＜ 0.05).Hepatic cirrhosis was the independent risk factor of late recurrence(RR = 2.809, P ＜ 0.05).The 1-,3-,5-year overall survival rates and tumor-free survival rates were 82.6％,60.8％,54.9％ and 65.0％,38.5％,23.1％.There were significant differences in overall survival and disease-free survival rates among patients with AFP ＜20 μg/L,AFP/V ＜ 14 μg/(L · cm3)or AFP/V ≥ 14 μg/(L · cm3)(P ＜ 0.05).The 1-,3-,5-year overall survival rates of patients with early tumor recurrence were 64.9％,23.0％ and 20.5％,respectively,and the 1-,3-,5-year overall survival rates of patients with late tumor recurrence were 100.0％,88.5％ and 72.5％,respectively.A significant difference in the 1-,3-,5-year overall survival rates between patients with early or late tumor recurrence was observed(x2 = 26.918,P ＜0.05).Conclusions AFP/V,tumor number,blood vessel invasion were independent risk factors of early tumor recurrence,and hepatic cirrhosis was the independent risk factor of late tumor recurrence.There is a significant difference in the survival rate between patients with early or late tumor recurrence.
