摘要
目的探讨外周血中CD4^+/CD8^+值的大小与肝癌切除术后预后的关系。方法回顾性分析2008年10月-2011年11月在中国人民解放军第一八○医院行肝癌部分切除术150例患者的临床资料。检测患者术前外周静脉血CD4^+/CD8^+值,并分为低CD4^+/CD8^+值组(CD4^+/CD8^+值≤1,52例)和高CD4^+/CD8^+值组(CD4^+/CD8^+值>1,98例),比较2组临床指标,并采用门诊随访与电话随访相结合,记录2组患者生存率和肿瘤复发情况。计数资料组间比较采用χ~2检验,两组生存分析采用Kaplan-Meier法(Log-Rank检验)对相关临床因素采用单因素及多因素Logistic回归分析。结果低CD4^+/CD8^+值组的第1、3、5年生存率低于高CD4^+/CD8^+值组,差异均有统计学意义(χ~2值分别为36.473、41.983、55.214,P值均<0.001),2组的5年生存率比较差异有统计学意义(χ~2=81.471,P<0.05);低CD4^+/CD8^+值组的第1、3、5年肿瘤复发率均高于高CD4^+/CD8^+值组,差异均有统计学意义(χ~2值分别为44.041、68.234、55.157,P值均<0.05)。单因素分析显示CD4^+/CD8^+值、肿癌直径、有无子灶、HBV感染、肿瘤浸润深度、微血管侵犯、淋巴结转移和肿瘤分化程度是影响肝癌切除术后复发的高风险因素,多因素分析结果显示CD4^+/CD8^+值、肿癌直径、肿瘤分化程度、淋巴结转移及微血管侵犯是影响肝癌切除术后复发的独立危险因素。结论肝癌切除术前CD4^+/CD8^+值≤1患者的预后较差,复发率高,CD4^+/CD8^+值对肝癌术后的预后具有一定的预测价值。
Objective To investigate the association between CD4^＋/ CD8^＋ratio in peripheral blood and patient prognosis after hepatectomy for liver cancer. Methods The clinical data of 150 patients who received partial hepatectomy for liver cancer in the 180 Hospital of PLA from October 2008 to November 2011 were analyzed retrospectively. CD4^＋/ CD8^＋ratio in peripheral venous blood was measured before surgery,and the patients were divided into low- CD4^＋/ CD8^＋group（ CD4^＋/ CD8^＋ratio ≤1,52 patients） and high- CD4^＋/ CD8^＋group（ CD4^＋/ CD8^＋ratio 1,98 patients）. Clinical indices were compared between the two groups,and outpatient follow- up and telephone follow- up were applied to record survival rate and tumor recurrence. The chi- square test was applied for comparison between the two groups,and Kaplan- Meier method（ log- rank test） was applied for survival analysis. Univariate and multivariate logistic regression analyses were performed for clinical factors to determine the related risk factors for recurrence after hepatectomy for liver cancer. Results The low- CD4 ＋ / CD8 ＋ group had significantly lower 1-,3-,and 5- year survival rates than the high- CD4^＋/ CD8^＋group（ χ^2= 36. 473,41. 983,and 55. 214,respectively; all P 0. 001）,and the 5- year survival rate differed significantly between the two groups（ χ^2= 81. 471;P 0. 05）; the low- CD4^＋/ CD8^＋group had significantly higher 1-,3-,and 5- year tumor recurrence rates than the high- CD4^＋/CD8^＋group（ χ^2= 44. 041,68. 234,and 55. 157,respectively; all P 0. 05）. Univariate analysis showed that CD4^＋/ CD8^＋ratio,tumor diameter,existence of satellite lesions,hepatitis B virus infection,depth of tumor invasion,microvascular invasion,lymph node metastasis,and degree of tumor differentiation were high risk factors for recurrence after resection of liver cancer. Multivariate analysis showed that CD4^＋/CD8^＋ratio,tumor diameter,degree of tumor differentiation,lymph node metastasis,and microvascular invasion were independent risk factors for recurrence after resection of liver cancer. Conclusion The patients with a CD4^＋/ CD8^＋ratio of ≤1 before resection of liver cancer have poor prognosis and high recurrence rates,and CD4^＋/ CD8^＋ratio has a certain predictive value for prognosis after resection of liver cancer.
出处
《临床肝胆病杂志》
CAS
2015年第12期2066-2069,共4页
Journal of Clinical Hepatology
