摘要
目的探讨单发肝细胞癌(SHCC)发生微血管侵犯的影响因素及患者预后情况。方法回顾性分析2012年1月-2014年12月吉林大学第一医院收治的138例行肝癌根治术SHCC患者的临床病理资料。根据中性粒细胞、PLT、纤维蛋白原、中性粒细胞与淋巴细胞比值、PLT与淋巴细胞比值、纤维蛋白原与Alb比值和是否发生微血管侵犯绘制受试者工作特征曲线,依据约登指数确定各指标的临界值。应用logistic回归模型行单因素和多因素分析,比值比(OR)和95%可信区间(95%CI)评价联系的紧密性。对微血管侵犯阳性与阴性患者应用Kaplan-Meier法计算无瘤生存率,并绘制生存曲线,采用log-rank检验进行比较。结果单因素分析显示,与SHCC微血管侵犯相关的因素有性别(OR=0.400,95%CI:0.162~0.985,P=0.046)、肿瘤直径(OR=5.902,95%CI:2.813~12.382,P<0.001)、AFP(OR=2.635,95%CI:1.286~5.398,P=0.008)、中性粒细胞(OR=3.019,95%CI:1.353~6.736,P=0.007)、PLT(OR=2.255,95%CI:1.116~4.555,P=0.023)、纤维蛋白原(OR=3.483,95%CI:1.687~7.190,P=0.001)、GGT(OR=2.115,95%CI:1.069~4.182,P=0.031)、中性粒细胞与淋巴细胞比值(OR=3.662,95%CI:1.803~7.436,P<0.001)、PLT与淋巴细胞比值(OR=3.734,95%CI:1.649~8.455,P=0.002)、纤维蛋白原与Alb比值(OR=3.014,95%CI:1.497~6.070,P=0.002)。多因素分析显示,肿瘤直径(OR=5.423,95%CI:2.555~11.511,P<0.001)和AFP(OR=2.195,95%CI:1.010~4.774,P=0.047)是微血管侵犯的独立相关因素。预后研究结果表明,有微血管侵犯组患者1、3年无瘤生存率为66.4%、52.8%,无微血管侵犯组患者1、3年无瘤生存率为90.6%、71.5%,2组患者1、3年无瘤生存率比较差异有统计学意义(χ2值分别为10.929、4.043,P值均<0.05)。2组无瘤生存曲线比较,差异亦有统计学意义(χ2=7.860,P=0.005)。结论肿瘤直径、术前AFP水平是SHCC发生微血管侵犯的独立相关因素,SHCC伴有微血管侵犯者预后较差。
Objective To investigate the influencing factors for microvascular invasion（MVI） in patients with single hepatocellular carcinoma（SHCC） and their prognosis. Methods A retrospective analysis was performed for the clinical data of 138 patients with SHCC who were admitted to The First Hospital of Jilin University from January 2012 to December 2014 and underwent radical hepatectomy. The receiver operating characteristic curve was plotted based on neutrophil,platelet count（PLT）,fibrinogen,neutrophil-lymphocyte ratio,platelet-lymphocyte ratio,fibrinogen-albumin ratio,and presence or absence of MVI. The logistic regression model was used for univariate and multivariate analyses,and odds ratio（OR） and 95% confidence interval（CI） were used to evaluate association. The Kaplan-Meier method was used to calculate disease-free survival rate and plot survival curves of patients with or without MVI,and the log-rank test was used for survival analysis. Results The univariate analysis showed that sex（OR = 0. 400,95% CI： 0. 162-0. 985,P = 0. 046）,tumor diameter（OR =5. 902,95% CI： 2. 813-12. 382,P〈0. 001）,alpha-fetoprotein（AFP）（OR = 2. 635,95% CI： 1. 286-5. 398,P = 0. 008）,neutrophil（OR = 3. 019,95% CI： 1. 353-6. 736,P = 0. 007）,PLT（OR = 2. 255,95% CI： 1. 116-4. 555,P = 0. 023）,fibrinogen（OR =3. 483,95% CI： 1. 687-7. 190,P = 0. 001）,gamma-glutamyl transferase（OR = 2. 115,95% CI： 1. 069-4. 182,P = 0. 031）,neutrophil-lymphocyte ratio（OR = 3. 662,95% CI： 1. 803-7. 436,P〈0. 001）,platelet-lymphocyte ratio（OR = 3. 734,95% CI： 1. 649-8. 455,P = 0. 002）,and fibrinogen-albumin ratio（OR = 3. 014,95% CI： 1. 497-6. 070,P = 0. 002） were associated with MVI in patients with SHCC. The multivariate analysis indicated that tumor diameter（OR = 5. 423,95% CI： 2. 555-11. 511,P〈0. 001） and AFP（OR = 2. 195,95% CI： 1. 010-4. 774,P = 0. 047） were independent factors for MVI. The prognostic analysis showed that the 1-and3-year disease-free survival rates we
作者
胡月雷
孙大伟
骆飞翔
刘欢
吕国悦
HU Yuelei;SUN Dawei;LUO Feixiang(First Department of Hepatobiliary-pancreatic-splenic Surgery,The First Hospital of Jilin University,Changchun 130000,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2018年第9期1911-1916,共6页
Journal of Clinical Hepatology
关键词
癌
肝细胞
微血管侵犯
危险因素
carcinoma
hepatocellular
microvascular invasion
risk factors
