摘要
目的分析肝细胞癌合并门静脉癌栓(PVTT)手术切除后预后影响因素。方法回顾分析2008年1月至2019年6月在宁波大学附属李惠利医院行手术切除的98例肝细胞癌合并PVTT患者资料,其中男性83例,女性15例,平均年龄53岁。回顾分析临床和随访资料。Kaplan-Meier法计算生存率,log-rank检验比较生存率。患者预后多因素分析采用Cox回归模型。结果患者术后1、2、3年累积生存率分别为75.9%、51.5%、35.4%,中位生存期为25个月;1、2、3年无病生存率分别为35.0%、16.1%、8.6%,中位无病生存期为8个月。多因素分析,术前甲胎蛋白≥400μg/L(HR=1.760,95%CI:1.079~2.873)、肝静脉癌栓(HR=3.809,95%CI:1.655~8.765)的肝细胞癌合并PVTT患者手术切除后总体生存预后更差(均P<0.05),术后辅助TACE(HR=0.397,95%CI:0.220~0.716,P=0.002)的患者生存预后更佳。多因素分析,术前甲胎蛋白≥400μg/L(HR=2.339,95%CI:1.488~3.676)、肝细胞癌切除联合PVTT清除术(HR=2.038,95%CI:1.090~3.811)、肝静脉癌栓(HR=2.374,95%CI:1.160~4.857)是肝细胞癌合并PVTT患者手术切除后复发的危险因素(均P<0.05),术后辅助TACE(HR=0.535,95%CI:0.307~0.933,P=0.027)是复发的保护因素。结论术前甲胎蛋白≥400μg/L及合并肝静脉癌栓是肝细胞癌合并PVTT患者预后的独立危险因素,合理选择手术方式和术后辅助TACE可以进一步改善患者预后。
Objective To analyze prognostic factors of hepatocellular carcinoma(HCC)combined with portal vein tumor thrombus(PVTT)after surgical resection.Methods The data of 98 patients with HCC combined with PVTT who underwent surgical resection in Ningbo University Affiliated Li Huili Hospital from January 2008 to June 2019 were analyzed retrospectively,including 83 males and 15 females with an average age of 53 years.The survival rate was calculated by Kaplan-Meier method and compared using log-rank test.Cox regression model was used for the multivariate analysis of the prognosis of patients.Results The 1,2,and 3-year overall survival rates were 75.9%,51.5%,and 35.4%,respectively,with a median survival time of 25 months;the 1,2,and 3-year disease-free survival rates were 35.0%,16.1%,and 8.6%,respectively,with a median disease-free survival time of 8 months.Multivariate analysis showed that the overall survival of patients with preoperative alpha-fetoprotein(AFP)≥400μg/L(HR=1.760,95%CI:1.079-2.873)and hepatic vein tumor thrombus(HVTT,HR=3.809,95%CI:1.655-8.765)was poorer after surgical resection(all P<0.05),while the survival of patients with postoperative adjuvant trans-arterial chemoembolization(TACE)(HR=0.397,95%CI:0.220-0.716,P=0.002)was better.Preoperative AFP≥400μg/L(HR=2.339,95%CI:1.488-3.676),undergoing HCC resection combined with PVTT dissection(HR=2.038,95%CI:1.090-3.811),and with HVTT(HR=2.374,95%CI:1.160-4.857)(all P<0.05)are independent risk factors for recurrence in patients with HCC combined with PVTT,postoperative adjuvant TACE(HR=0.535,95%CI:0.307-0.933,P=0.027)is a protective factor.Conclusion Preoperative AFP≥400μg/L and HVTT are independent risk factors for the prognosis of patients with HCC combined with PVTT.Reasonable selection of surgical methods and postoperative adjuvant TACE may improve the prognosis of patients.
作者
骆华刚
黄静
毛书奇
陆才德
Luo Huagang;Huang Jing;Mao Shuqi;Lu Caide(Department of Hepatopancreatobiliary Surgery,Ningbo Medical Center Lihuili Hospital,Ningbo University,Ningbo 315040,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2021年第11期810-814,共5页
Chinese Journal of Hepatobiliary Surgery
基金
宁波市医疗卫生品牌学科(PPXK2018-03)。
关键词
癌
肝细胞
门静脉
预后
肝切除术
Carcinoma,hepatocellular
Portal vein
Prognosis
Hepatectomy
