摘要
目的探讨微血管侵犯(MVI)对早期肝癌肝切除术切缘选择及患者预后的影响。方法选取2015年1月至2016年12月我院收治的早期肝癌肝切除术患者60例为研究对象,根据病史资料分为MVI阳性组及MVI阴性组,分析导致肝癌患者发生MVI的单因素及独立危险因素,并对比MVI阳性及阴性患者中不同切缘患者1年复发率、生存率,以Cox等比例风险模型评价肿瘤复发及总体生存的独立预测因子,比较不同切缘患者术后并发症。结果与MVI阴性组比较,MVI阳性组手术切缘(1.05±0.07)cm、病灶大小(6.57±1.23)cm、血清甲胎蛋白(AFP)(213.13±13.58)μg/L及肿瘤边缘不光滑70.00%、包膜不完整90.00%、肿瘤多发比例35.00%明显较高(P<0.05);Logistic回归分析显示肿瘤边缘不光滑、肿瘤多发为预测早期肝癌患者微血管侵犯的独立危险因素(P<0.05);MVI阳性患者中中宽切缘者1年复发率55.56%高于窄切缘者9.09%(P<0.05),1年总体生存率66.67%低于窄切缘者100.00%(P<0.05);多因素Cox分析显示AFP≥400μg/L、切缘<1cm、肿瘤>5cm是MVI阳性患者肿瘤复发及病人总体生存的独立预测因子(P<0.05);接受中宽切缘或窄切缘患者术后1年并发症发生率15.63%、14.29%比较无显著差异(P>0.05)。结论肿瘤边缘不光滑、肿瘤多发是预测微血管侵犯的独立危险因素,对于发生微血管侵犯患者选择中宽切缘能显著延长生存期,降低复发率,改善预后。
Objective To investigate the effect of microvascular invasion（ MVI） on the choice of resection margin of hepatectomy for early stage liver cancer and the prognosis of patients. Methods 60 cases undergoing hepatectomy for early stage liver cancer in our hospitalfrom January 2015 to December 2016 were selected as subjects. According to the medical data,the patients were divided into MVI positive group and MVI negative group. The single factors and independent risk factors for the occurrence of MVI in patients with liver cancer were analyzed. The 1-year recurrence rates and survival rates of patients with different resection margins were compared between the two groups. The independent predictors of tumor recurrence and overall survival were evaluated with the Cox proportional hazard model,and the complications were compared between patients with different resection margins. Results Compared with MVI negative group,the resection margin,the size of lesions,serum alpha fetoprotein（ AFP） level,rates of rough edge of tumor,incomplete capsule and multiple tumors were significantly higher in MVI positive group（ P 0. 05）. Logistic regression analysis showed that rough edge of tumorand multiple tumors were the independent risk factors for predicting MVI in patients with early stage liver cancer（ P 0. 05）. In MVI positive group,the 1-year recurrence rate in patients with wide margin was higher than that in those with narrow margin（ 55. 56% vs 9. 09%） while the 1-year overall survival rate was lower than that of patients with narrow margin（ 66. 67% vs100. 00%）（ P 0. 05）. Cox multivariate analysis showed that AFP level ≥400μg/L,resection margin 1 cm and tumor 5 cm were the independent predictors of tumor recurrence and overall survival of patients with positive MVI（ P 0. 05）. The incidence of complications showed no significant difference between patients with wide margins and patients with narrow margins（ 15. 63% vs14. 29%）（ P 0. 05）. Conclusion The rough edge of tumor and multiple t
出处
《肝胆外科杂志》
2017年第5期353-357,共5页
Journal of Hepatobiliary Surgery
关键词
微血管侵犯
早期
肝癌
肝切除术
切缘
预后
microvascular invasion
early stage
liver cancer
hepatectomy
resection margin
prognosis
