中华肝胆外科杂志
中華肝膽外科雜誌
중화간담외과잡지
CHINESE JOURNAL OF HEPATOBILIARY SURGERY
2014年
4期
258-264
,共7页
朱倩%乔国梁%晏建军%吴孟超%严以群
硃倩%喬國樑%晏建軍%吳孟超%嚴以群
주천%교국량%안건군%오맹초%엄이군
肝细胞癌%肝硬化%预后%肝切除%危险因素
肝細胞癌%肝硬化%預後%肝切除%危險因素
간세포암%간경화%예후%간절제%위험인소
Hepatocellular carcinoma%Cirrhosis%Prognosis%Hepatic resection%Risk factors
目的 研究乙肝肝硬化相关早期肝癌肝切除术复发危险因素及预后.方法 通过临床监测、流行病学和终末结果数据库确诊早期肝癌,包括肿瘤直径≤5 cm,没有肝内转移灶、远处转移或者主要血管侵犯.所有患者均施行肝切除术(不包括射频及肝移植术).2005年4月至2010年11月东方肝胆外科医院共确诊肝癌患者20 700例.本文回顾性分析其中537例早期肝癌患者的临床特点和预后因素.生存分析使用Kaplan-Meier函数及Cox模型.结果 537例乙肝肝硬化早期肝癌患者的中位肿瘤直径为2.9 cm,其中33％的患者肿瘤直径≤2 cm.绝大多数早期肝癌患者肿瘤单发(63％)且没有血管侵犯证据(64％).术后总体中位生存时间及5年生存率分别为45个月及33％.综合分析年龄、性别及病理分期等因素显示,肿瘤直径＞2 cm[风险比(HR):1.56]、多病灶(HR:1.34)、血管侵犯(HR:2.03)为影响预后的独立危险因素(P＜0.05).根据这些研究结果,建立一个早期肝癌预后评分系统,分成4个组(中位生存时间及5年生存率),0分(97个月,96％),1分(85个月,76％),2分(76个月,54％),3分(56个月,39％),各组间差异有统计学意义(P＜0.01).结论 病理分期对于早期肝癌手术预后的判断具有重要意义,解剖性肝切除是乙肝肝硬化相关早期肝细胞癌患者最佳手术选择.
目的 研究乙肝肝硬化相關早期肝癌肝切除術複髮危險因素及預後.方法 通過臨床鑑測、流行病學和終末結果數據庫確診早期肝癌,包括腫瘤直徑≤5 cm,沒有肝內轉移竈、遠處轉移或者主要血管侵犯.所有患者均施行肝切除術(不包括射頻及肝移植術).2005年4月至2010年11月東方肝膽外科醫院共確診肝癌患者20 700例.本文迴顧性分析其中537例早期肝癌患者的臨床特點和預後因素.生存分析使用Kaplan-Meier函數及Cox模型.結果 537例乙肝肝硬化早期肝癌患者的中位腫瘤直徑為2.9 cm,其中33％的患者腫瘤直徑≤2 cm.絕大多數早期肝癌患者腫瘤單髮(63％)且沒有血管侵犯證據(64％).術後總體中位生存時間及5年生存率分彆為45箇月及33％.綜閤分析年齡、性彆及病理分期等因素顯示,腫瘤直徑＞2 cm[風險比(HR):1.56]、多病竈(HR:1.34)、血管侵犯(HR:2.03)為影響預後的獨立危險因素(P＜0.05).根據這些研究結果,建立一箇早期肝癌預後評分繫統,分成4箇組(中位生存時間及5年生存率),0分(97箇月,96％),1分(85箇月,76％),2分(76箇月,54％),3分(56箇月,39％),各組間差異有統計學意義(P＜0.01).結論 病理分期對于早期肝癌手術預後的判斷具有重要意義,解剖性肝切除是乙肝肝硬化相關早期肝細胞癌患者最佳手術選擇.
목적 연구을간간경화상관조기간암간절제술복발위험인소급예후.방법 통과림상감측、류행병학화종말결과수거고학진조기간암,포괄종류직경≤5 cm,몰유간내전이조、원처전이혹자주요혈관침범.소유환자균시행간절제술(불포괄사빈급간이식술).2005년4월지2010년11월동방간담외과의원공학진간암환자20 700례.본문회고성분석기중537례조기간암환자적림상특점화예후인소.생존분석사용Kaplan-Meier함수급Cox모형.결과 537례을간간경화조기간암환자적중위종류직경위2.9 cm,기중33％적환자종류직경≤2 cm.절대다수조기간암환자종류단발(63％)차몰유혈관침범증거(64％).술후총체중위생존시간급5년생존솔분별위45개월급33％.종합분석년령、성별급병리분기등인소현시,종류직경＞2 cm[풍험비(HR):1.56]、다병조(HR:1.34)、혈관침범(HR:2.03)위영향예후적독립위험인소(P＜0.05).근거저사연구결과,건립일개조기간암예후평분계통,분성4개조(중위생존시간급5년생존솔),0분(97개월,96％),1분(85개월,76％),2분(76개월,54％),3분(56개월,39％),각조간차이유통계학의의(P＜0.01).결론 병리분기대우조기간암수술예후적판단구유중요의의,해부성간절제시을간간경화상관조기간세포암환자최가수술선택.
Objective To identify clinicopathologic factors which predict survival following hepatectomy in HBV-related cirrhotic patients with early hepatocellular carcinoma (HCC).Methods A database was used to identify patients with histologically confirmed early HCC (≤5 cm,no nodal involvement,metastases,or major vascular invasion) who underwent surgical resection (excluding ablation or transplantation).Among 20 700 patients with HCC who were diagnosed at the Eastern Hepatobiliary Surgery Hospital from April 2005 to November 2010,537 (2.6％) patients with early HCC were studied retrospectively.Prognostic factors were evaluated using the Kaplan-Meier curves,Cox proportional hazards models and the receiver operating characteristic (ROC) curves.Results The study included 537 patients.The median tumor size was 2.9 cm,and 33％ of patients had tumors ≤2 cm.Most HCC lesions were solitary (63％) and had no evidence of vascular invasion (64％).Following surgery,the overall median and 5-year survival were 45 months and 33％ respectively.After adjusting for demographic factors and histological grade,tumor size ＞2 cm (hazard ratio [HR]:1.56),multifocal tumors (HR:1.34),and vascular invasion (HR:2.03) remained independent predictors of poor survival (all P ＜ 0.05).Based on these findings,a prognostic scoring system was developed that allotted 1 point each for these factors.Patients with early HCC could be stratified into 4 distinct prognostic groups (median and 5-year survival,respectively):0 points (97 months,96％),1 point (85 months,76％),2 points (76 months,54％),3 points (56 months,39％) (P ＜0.01).Conclusions The present study emphasized the importance of pathologic staging even in patients with small HCC.Anatomical resection of HCC should be the preferred surgical procedure in cirrhotic patients.
