CAJ | 학술논문

目的：探讨肿瘤直径与肝细胞癌（肝癌）肝切除患者预后的关系。方法回顾性分析2002年12月至2011年12月在西安交通大学第一附属医院行根治性肝切除并经病理学检查证实为肝癌的172例患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定。其中男139例，女33例；年龄≤55岁98例，>55岁74例。绘制患者术后生存时间和肿瘤直径关系的受试者工作特征（ROC）曲线，确定肿瘤直径界值为5.75 cm。根据最佳界值将患者分为小肝癌组（肿瘤直径<5.75 cm，85例）和大肝癌组（肿瘤直径≥5.75 cm，87例）。分析肿瘤直径与临床病理学参数关系。比较两组患者中位生存期、累积生存率、无瘤生存率。将临床病理学参数纳入影响患者生存预后的因素进行独立危险因素分析。肿瘤直径与临床病理学参数关系采用χ2检验，生存预后分析采用Kaplan-Meier法和Log-rank检验。单因素和多因素分析采用Cox比例风险模型。结果肿瘤直径与患者术前AFP、肿瘤数目、TNM分期有关（χ2=13.272，9.378，7.311；P<0.05）。大肝癌组的中位生存期为24个月，中位复发时间9个月；小肝癌组相应为39、37个月。大肝癌组的1、3、5年累积生存率分别为65.5%、36.0%、22.9%，小肝癌组相应为89.5%、76.3%、72.5%，大肝癌组的总体生存率明显低于小肝癌组（χ2=33.644，P<0.05）。大肝癌组的1、3、5年无瘤生存率分别为44.7%、25.5%、21.9%，小肝癌组相应为84.8%、67.8%、66.3%，大肝癌组的无瘤生存率明显低于小肝癌组（χ2=38.908，P<0.05）。术前Plt≥155×109/L、肿瘤直径>5.75 cm和TNM分期晚期是影响肝癌患者术后预后的独立危险因素（HR=1.588，3.066，2.029；P<0.05）。结论肿瘤直径是影响肝癌肝切除术患者预后的独立危险因素，肿瘤直径>5.75 cm患者预后差。
목적：탐토종류직경여간세포암（간암）간절제환자예후적관계。방법회고성분석2002년12월지2011년12월재서안교통대학제일부속의원행근치성간절제병경병이학검사증실위간암적172례환자림상자료。소유환자균첨서지정동의서，부합의학윤리학규정。기중남139례，녀33례；년령≤55세98례，>55세74례。회제환자술후생존시간화종류직경관계적수시자공작특정（ROC）곡선，학정종류직경계치위5.75 cm。근거최가계치장환자분위소간암조（종류직경<5.75 cm，85례）화대간암조（종류직경≥5.75 cm，87례）。분석종류직경여림상병이학삼수관계。비교량조환자중위생존기、루적생존솔、무류생존솔。장림상병이학삼수납입영향환자생존예후적인소진행독립위험인소분석。종류직경여림상병이학삼수관계채용χ2검험，생존예후분석채용Kaplan-Meier법화Log-rank검험。단인소화다인소분석채용Cox비례풍험모형。결과종류직경여환자술전AFP、종류수목、TNM분기유관（χ2=13.272，9.378，7.311；P<0.05）。대간암조적중위생존기위24개월，중위복발시간9개월；소간암조상응위39、37개월。대간암조적1、3、5년루적생존솔분별위65.5%、36.0%、22.9%，소간암조상응위89.5%、76.3%、72.5%，대간암조적총체생존솔명현저우소간암조（χ2=33.644，P<0.05）。대간암조적1、3、5년무류생존솔분별위44.7%、25.5%、21.9%，소간암조상응위84.8%、67.8%、66.3%，대간암조적무류생존솔명현저우소간암조（χ2=38.908，P<0.05）。술전Plt≥155×109/L、종류직경>5.75 cm화TNM분기만기시영향간암환자술후예후적독립위험인소（HR=1.588，3.066，2.029；P<0.05）。결론종류직경시영향간암간절제술환자예후적독립위험인소，종류직경>5.75 cm환자예후차。
ObjectiveTo investigate the association between tumor size and prognosis of patients with hepatocellular carcinoma (HCC) after hepatectomy.MethodsClinical data of 172 patients undergoing radical hepatectomy and diagnosed as HCC by pathological examination in the First Afifliated Hospital of Xi'an Jiaotong University between December 2002 and December 2011 were retrospectively studied. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 172 patients, 139 were males and 33 were females; 98 were with age≤55 years old and 74 were with age >55 years old. The receiver operating characteristic (ROC) curve of the relationship between postoperative survival time and tumor size was drawn, and the cut-off value for tumor size was determined at 5.75 cm. According to the best cut-off value, the patients were divided into the small HCC group (tumor size < 5.75 cm,n=85) and huge HCC group (tumor size≥5.75 cm,n=87). The relationship between tumor size and clinicopathologic parameters was analyzed, and the median survival time, cumulative survival rate and disease free survival rate of two groups were compared. The clinicopathologic parameters were included as the factors inlfuencing the survival and prognosis of patients, and independent risk factor analysis was performed. The relationship between tumor size and clinicopathologic parameters was analyzed using Chi-square test. Kaplan-Meier method and Log-rank test were used for survival and prognosis analysis. Cox proportional hazard model was used for univariate analysis and multivariate analysis.ResultsTumor size was associated with the preoperative AFP, number of tumors and TNM staging (χ2=13.272, 9.378, 7.311;P<0.05). The median survival time and the median recurrence time for the huge HCC group were 24 months and 9 months respectively and were 39 months and 37 months for the small HCC group. The 1-, 3-, 5-year cumulative survival rate for the huge HCC group were 65.5%, 36.0%, 22.9% respectively and were 89.5%, 76.3%, 72.5% respectively for the small HCC group. The overall survival of the huge HCC group was lower than that of small HCC group (χ2=33.644,P<0.05). The 1-, 3-, 5-year disease free survival rate for the huge HCC group were 44.7%, 25.5%, 21.9% respectively and were 84.8%, 67.8%, 66.3% respectively for the small HCC group. The disease free survival rate of huge HCC group was lower than that of small HCC group (χ2=38.908,P<0.05). Preoperative platelets count (Plt)≥155×109/L, tumor size > 5.75 cm and advanced stage of TNM were the independent risk factors inlfuencing the postoperative prognosis of HCC patients (HR=1.588, 3.066, 2.029;P<0.05).ConclusionsTumor size is the independent risk factor inlfuencing the prognosis of HCC patients after hepatectomy. The prognosis of patients with tumor size > 5.75 cm is poor.