中华肿瘤杂志
中華腫瘤雜誌
중화종류잡지
CHINESE JOURNAL OF ONCOLOGY
2014年
6期
430-434
,共5页
赵建军%阎涛%毕新宇%赵宏%黄振%周健国%李智宇%李聪%蔡建强
趙建軍%閻濤%畢新宇%趙宏%黃振%週健國%李智宇%李聰%蔡建彊
조건군%염도%필신우%조굉%황진%주건국%리지우%리총%채건강
肝细胞肝癌%肝切除术%癌胚抗原%生存率%预后
肝細胞肝癌%肝切除術%癌胚抗原%生存率%預後
간세포간암%간절제술%암배항원%생존솔%예후
Hepatocellular carcinoma%Hepatectomy%Carcinoembryonic antigen%Survival rate%Prognosis
目的 探讨术前血清癌胚抗原(CEA)表达水平与肝细胞肝癌(HCC)患者预后的关系.方法 回顾性分析562例外科治疗HCC患者的临床资料,采用Kaplan-Meier法进行生存分析,应用Cox比例风险模型进行多因素回归分析.结果 CEA诊断HCC的敏感性为7.1％ (40/562),CEA和甲胎蛋白(AFP)两者联合诊断HCC的敏感性为55.3％ (311/562).CEA阳性表达者(CEA≥5 ng/ml)具有较高的酗酒史和肿瘤多发比例.CEA阳性表达组患者的术后1、3和5年生存率分别为87.5％、60.5％和46.6％,CEA阴性表达组患者的术后1、3和5年生存率分别为93.8％、75.6％和59.4％,差异有统计学意义(P=0.045).CEA阳性表达组患者的术后1、3和5年无复发生存率分别为52.6％、36.2％和25.4％,CEA阴性表达组患者的术后1、3和5年无复发生存率分别为75.0％、55.9％和44.5％,差异有统计学意义(P =0.003).单因素分析结果显示,肿瘤直径≤5 em、肿瘤单发、无脉管癌栓、血清AFP阴性、血清CEA阴性、无或轻度肝硬化、无腹腔淋巴结转移、无大血管侵犯、无肿瘤破裂或肝外侵犯、无术中输血以及BCLC分期早的患者的中位无复发生存时间明显延长(均P＜0.05);肿瘤直径≤5 cm、肿瘤单发、病理分级为Ⅰ～Ⅱ级、无脉管癌栓、血清AFP阴性、血清CEA阴性、无或轻度肝硬化、无腹腔淋巴结转移、无大血管侵犯、无肿瘤破裂或肝外侵犯、无术中输血以及BCLC分期早的患者中位生存时间明显延长(均P＜0.05).Cox多因素分析结果显示,血清AFP阴性、血清CEA阴性、无或轻度肝硬化、无肿瘤破裂或肝外侵犯、无术中输血以及BCLC分期早是影响肝癌患者术后无复发生存的独立保护因素(均P＜0.05).血清AFP阴性、血清HBsAg阴性、无或轻度肝硬化、无病理脉管癌栓、无肿瘤破裂或肝外侵犯、无术中输血以及BCLC分期早是影响肝癌患者术后长期生存的独立保护因素(均P＜0.05).结论 血清CEA阳性表达患者具有较高的酗酒比例和肿瘤多发比例.虽然血清CEA表达水平对于HCC的诊断具有局限性,但其与HCC患者的预后有关,血清CEA表达水平是影响肝癌患者术后无复发生存的独立因素.
目的 探討術前血清癌胚抗原(CEA)錶達水平與肝細胞肝癌(HCC)患者預後的關繫.方法 迴顧性分析562例外科治療HCC患者的臨床資料,採用Kaplan-Meier法進行生存分析,應用Cox比例風險模型進行多因素迴歸分析.結果 CEA診斷HCC的敏感性為7.1％ (40/562),CEA和甲胎蛋白(AFP)兩者聯閤診斷HCC的敏感性為55.3％ (311/562).CEA暘性錶達者(CEA≥5 ng/ml)具有較高的酗酒史和腫瘤多髮比例.CEA暘性錶達組患者的術後1、3和5年生存率分彆為87.5％、60.5％和46.6％,CEA陰性錶達組患者的術後1、3和5年生存率分彆為93.8％、75.6％和59.4％,差異有統計學意義(P=0.045).CEA暘性錶達組患者的術後1、3和5年無複髮生存率分彆為52.6％、36.2％和25.4％,CEA陰性錶達組患者的術後1、3和5年無複髮生存率分彆為75.0％、55.9％和44.5％,差異有統計學意義(P =0.003).單因素分析結果顯示,腫瘤直徑≤5 em、腫瘤單髮、無脈管癌栓、血清AFP陰性、血清CEA陰性、無或輕度肝硬化、無腹腔淋巴結轉移、無大血管侵犯、無腫瘤破裂或肝外侵犯、無術中輸血以及BCLC分期早的患者的中位無複髮生存時間明顯延長(均P＜0.05);腫瘤直徑≤5 cm、腫瘤單髮、病理分級為Ⅰ～Ⅱ級、無脈管癌栓、血清AFP陰性、血清CEA陰性、無或輕度肝硬化、無腹腔淋巴結轉移、無大血管侵犯、無腫瘤破裂或肝外侵犯、無術中輸血以及BCLC分期早的患者中位生存時間明顯延長(均P＜0.05).Cox多因素分析結果顯示,血清AFP陰性、血清CEA陰性、無或輕度肝硬化、無腫瘤破裂或肝外侵犯、無術中輸血以及BCLC分期早是影響肝癌患者術後無複髮生存的獨立保護因素(均P＜0.05).血清AFP陰性、血清HBsAg陰性、無或輕度肝硬化、無病理脈管癌栓、無腫瘤破裂或肝外侵犯、無術中輸血以及BCLC分期早是影響肝癌患者術後長期生存的獨立保護因素(均P＜0.05).結論 血清CEA暘性錶達患者具有較高的酗酒比例和腫瘤多髮比例.雖然血清CEA錶達水平對于HCC的診斷具有跼限性,但其與HCC患者的預後有關,血清CEA錶達水平是影響肝癌患者術後無複髮生存的獨立因素.
목적 탐토술전혈청암배항원(CEA)표체수평여간세포간암(HCC)환자예후적관계.방법 회고성분석562예외과치료HCC환자적림상자료,채용Kaplan-Meier법진행생존분석,응용Cox비례풍험모형진행다인소회귀분석.결과 CEA진단HCC적민감성위7.1％ (40/562),CEA화갑태단백(AFP)량자연합진단HCC적민감성위55.3％ (311/562).CEA양성표체자(CEA≥5 ng/ml)구유교고적후주사화종류다발비례.CEA양성표체조환자적술후1、3화5년생존솔분별위87.5％、60.5％화46.6％,CEA음성표체조환자적술후1、3화5년생존솔분별위93.8％、75.6％화59.4％,차이유통계학의의(P=0.045).CEA양성표체조환자적술후1、3화5년무복발생존솔분별위52.6％、36.2％화25.4％,CEA음성표체조환자적술후1、3화5년무복발생존솔분별위75.0％、55.9％화44.5％,차이유통계학의의(P =0.003).단인소분석결과현시,종류직경≤5 em、종류단발、무맥관암전、혈청AFP음성、혈청CEA음성、무혹경도간경화、무복강림파결전이、무대혈관침범、무종류파렬혹간외침범、무술중수혈이급BCLC분기조적환자적중위무복발생존시간명현연장(균P＜0.05);종류직경≤5 cm、종류단발、병리분급위Ⅰ～Ⅱ급、무맥관암전、혈청AFP음성、혈청CEA음성、무혹경도간경화、무복강림파결전이、무대혈관침범、무종류파렬혹간외침범、무술중수혈이급BCLC분기조적환자중위생존시간명현연장(균P＜0.05).Cox다인소분석결과현시,혈청AFP음성、혈청CEA음성、무혹경도간경화、무종류파렬혹간외침범、무술중수혈이급BCLC분기조시영향간암환자술후무복발생존적독립보호인소(균P＜0.05).혈청AFP음성、혈청HBsAg음성、무혹경도간경화、무병리맥관암전、무종류파렬혹간외침범、무술중수혈이급BCLC분기조시영향간암환자술후장기생존적독립보호인소(균P＜0.05).결론 혈청CEA양성표체환자구유교고적후주비례화종류다발비례.수연혈청CEA표체수평대우HCC적진단구유국한성,단기여HCC환자적예후유관,혈청CEA표체수평시영향간암환자술후무복발생존적독립인소.
Objective To investigate the correlation between carcinoembryonic antigen (CEA) and prognosis of hepatocellular carcinoma after hepatectomy.Methods This study retrospectively analyzed the surgical outcomes of hepatocellular carcinoma (HCC) in 562 patients who underwent hepatectomy between January 2002 and December 2009 in the Cancer Hospital,Chinese Academy of Medical Sciences.Postoperative prognostic factors were analyzed using univariate Kaplan-Meier analysis and multivariate Cox proportional hazards model.Results The sensibility of serum CEA and CEA-AFP combined in the detection of HCC was 7.1％ (40/562) and 55.3％ (311/562),respectively.The 1-,3-and 5-year overall survival rates and disease free survival rates of CEA-negative group (CEA ＜ 5 ng/ml) were 93.8％,75.6％,59.4％,and 75.0％,55.9％,44.5％,respectively (P =0.003) ; and the 1-,3-and 5-year overall survival rates and disease free survival rates of CEA-positive group (CEA≥5 ng/ml) were 87.5％,60.5％,46.6％ and 52.6％,36.2％,and 25.4％,respectively (P =0.045).In the univariate analysis,better prognosis for overall survival (OS) was associated with small tumor (≤ 5 cm),single lesion,high-grade histological differentiation,no vascular tumor embolus,negative serum AFP expression,negative serum CEA expression,no/mild cirrhosis,no regional lymph node metastasis,no major vascular invasion,no direct invasion of adjacent organs or with perforation of visceral peritoneum,no transfusion as well as earlier BCLC staging (P ＜0.05 for all).In the Cox multivariate analysis,serum AFP-negative expression,serum CEA-negative expression,no/mild cirrhosis,no direct invasion of adjacent organs or with perforation of visceral peritoneum,no transfusion and earlier BCLC staging were independent factors for longer disease free survival (P ＜ 0.05 for all).Conclusions Serum CEA-positive expression is correlated to alcoholism and HCC multiple occurrences.Although serum CEA detection has limited value for HCC diagnosis,its positive expression does affect poor prognosis.Higher serum CEA level is an independent prognostic factor for poorer disease free survival.
