CAJ | 학술논문

目的探讨肝癌发生肺转移的危险因素,为防治肝癌肺转移提供理论依据.方法回顾性分析2008年1月至2012年3月福建医科大学附属第一医院收治的862例肝癌患者的临床资料.其中肺转移107例,将其血清AFP、GGT水平、是否合并HBV感染、肝内肿瘤情况、肝内肿瘤治疗情况等因素进行分析,寻找影响肝癌发生肺转移的危险因素.单因素分析采用COX比例风险模型,将有统计学意义的指标引入COX模型采用逐步后退法进一步进行多因素分析.结果单因素分析结果显示:AFP≥400 μg/L、GGT≥150 U/L、合并HBV感染、肝内肿瘤数目≥2个、肿瘤未经手术切除或RFA、合并血管癌栓、伴有淋巴结转移是影响肝癌发生肺转移的危险因素,差异有统计学意义(RR=1.986,3.653,0.365,3.675,0.252,0.379,0.352,P＜0.05).多因素COX逐步后退法分析结果显示:AFP≥400 μg/L、合并HBV感染、肝内肿瘤数目≥2个、肿瘤未经手术切除或RFA、合并血管癌栓、伴有淋巴结转移的肝癌患者更容易发生肺转移,差异有统计学意义(RR=2.391,3.462,3.425,3.396,2.418,0.638,P＜0.05).结论 AFP ≥400 μg/L、合并HBV感染、肝内肿瘤数目≥2个、肿瘤未经手术切除或RFA、合并血管癌栓、伴有淋巴结转移者是肝癌发生肺转移的危险因素,抗病毒治疗、早期积极手术治疗肝内瘤灶可能对防治肝癌发生肺转移有重要意义.
목적 탐토간암발생폐전이적위험인소,위방치간암폐전이제공이론의거.방법 회고성분석2008년1월지2012년3월복건의과대학부속제일의원수치적862례간암환자적림상자료.기중폐전이107례,장기혈청AFP、GGT수평、시부합병HBV감염、간내종류정황、간내종류치료정황등인소진행분석,심조영향간암발생폐전이적위험인소.단인소분석채용COX비례풍험모형,장유통계학의의적지표인입COX모형채용축보후퇴법진일보진행다인소분석.결과 단인소분석결과현시:AFP≥400 μg/L、GGT≥150 U/L、합병HBV감염、간내종류수목≥2개、종류미경수술절제혹RFA、합병혈관암전、반유림파결전이시영향간암발생폐전이적위험인소,차이유통계학의의(RR=1.986,3.653,0.365,3.675,0.252,0.379,0.352,P＜0.05).다인소COX축보후퇴법분석결과현시:AFP≥400 μg/L、합병HBV감염、간내종류수목≥2개、종류미경수술절제혹RFA、합병혈관암전、반유림파결전이적간암환자경용역발생폐전이,차이유통계학의의(RR=2.391,3.462,3.425,3.396,2.418,0.638,P＜0.05).결론 AFP ≥400 μg/L、합병HBV감염、간내종류수목≥2개、종류미경수술절제혹RFA、합병혈관암전、반유림파결전이자시간암발생폐전이적위험인소,항병독치료、조기적겁수술치료간내류조가능대방치간암발생폐전이유중요의의.
Objective To investigate the correlated factors of pulmonary metastasis of hepatocellular carcinoma (HCC),so as to provide theoretical evidences for the prevention and treatment.Methods The clinical data of 862 patients with HCC who were admitted to the First Affiliated Hospital of Fujian Medical University from January 2008 to March 2012 were retrospectively analyzed.There were 107 patients with pulmonary metastasis.Factors including serum alpha fetoprotein (AFP) level,serum gamma-glutamyl transpeptidase (GGT) level,hepatitis B virus (HBV) infection,presence and treatment of intrahepatic tumor were analyzed to screen out relevant factors of pulmonary infection of HCC.Univariate and multivariate COX regression model analysis were performed for data analysis.Results The results of univariate analysis showed that high level of AFP (≥400 μg/L),ultra-high level of GGT (≥ 150 U/L),presence of HBV infection,the number of intrahepatic tumors ≥2,no radical resection (or radiofrequency ablation) for intrahepatic tumors,combining with tumor thrombi in the vessels,lymph node metastasis were risk factors of pulmonary metastasis of HCC (RR =1.986,3.653,0.365,3.675,0.252,0.379,0.352,P ＜ 0.05).The results of multivariate analysis showed that high level of AFP (≥400 μg/L),HBV infection,the number of intrahepatic tumors ≥2,no radical resection (or radiofrequency ablation) for intrahepatic tumors,combining with tumor thrombi in the vessels were risk factors of pulmonary metastasis of HCC (RR =2.391,3.462,3.425,3.396,2.418,0.638,P ＜ 0.05).Conclusions AFP ≥400 μg/L,HBV infection,the number of intrahepatic tumors ≥ 2,no radical resection (or radiofrequency ablation),tumor thrombi in the vessels and lymph node metastasis are risk factors of pulmonary metastasis of HCC.Anti-hepatitis virus treatment and early treatment are helpful for the prevention and treatment.