摘要
目的探讨小肝癌手术切除治疗后肿瘤复发的危险因素为预测术后复发提供理论依据。方法研究回顾性分析了自2010年1月至2015年1月收治于新疆医科大学第一附属医院并行根治性手术切除治疗的157例原发性小肝癌患者的临床病理资料,并对患者复发情况进行追踪随访,随访至2020年1月。随访期间发生肿瘤复发的为A组、未发生肿瘤复发的B组。采用单因素分析肿瘤复发与患者临床病理资料之间的关系,多因素logistic回归模型分析小肝癌在根治性切除术后患者发生肿瘤复发的独立危险因素。结果根治性手术切除术后肿瘤复发患者(A组)66例(43.04%)。单因素分析结果显示:术前AFP浓度>400ug/L(P=0.01)、合并肝硬化(P=0.01)、合并乙肝(P=0.03)、术前HBV-DNA水平>200U/m L(P=0.03)、肿瘤包膜完整(P=0.04)、肿瘤最大直径>2 cm(P=0.04)、肿瘤细胞分化中低度(P=0.02)、预防性肝动脉化疗栓塞治疗(P=0.01)及术后规律性服用抗病毒药物(P=0.03)在A、B两组间差异具有统计学差异。多因素分析结果显示:术前AFP浓度>400 ug/L、合并肝硬化、合并乙肝、肿瘤细胞分化中低度是小肝癌切除术后导致肿瘤复发的独立危险因素(OR=1.44,1.45,3.79,1.60;95%CI=1.074.85,1.093.08,1.479.81,1.075.89;P=0.03、0.03、0.01、0.04);术后规律性服用抗病毒药物是小肝癌术后降低复发的保护因素(OR=0.41,95%Cl 0.450.97,P=0.04)。结论手术切除是治疗小肝癌的首选方法,术前AFP>400ug/L、合并肝硬化、合并乙肝及肿瘤细胞分化中低度是术后肿瘤复发的独立危险因素;术后预防性肝动脉化疗栓塞术不能降低患者术后肿瘤复发,而规律性服用抗病毒药物是降低肿瘤复发的保护因素。
Objective To explore the risk factors of tumor recurrence after surgical resection of small hepatocellular carcinoma and to provide theoretical basis for predicting postoperative recurrence.Methods The clinical data of 157 patients with small hepatocellular carcinoma who were admitted to the first affiliated hospital of Xinjiang medical university for concurrent radical surgical resection from January 2010 to January 2015 were retrospectively analyzed and followed up to January 2020.Tumor recurrence occurred in group A and group B during follow-up.Univariate analysis of the relationship between tumor recurrence and clinical data of the patients,and multivariate logistic regression model was used to analyze the independent risk factors of tumor recurrence in patients with small hepatocellular carcinoma after radical resection.Results Tumor recurrence occurred in 66 patients(43.04%)after radical surgical resection.Univariate analysis results showed that there were statistical differences between group A and B considering preoperative AFP concentration>400μg/L(P=0.01),liver cirrhosis(P=0.01),the combining of hepatitis B(P=0.03),preoperative HBV DNA level>200 u/m L(P=0.03),intact tumor envelope(P=0.04),tumor diameter>2 cm(P=0.04),low differentiatiated tumor cell(P=0.02),prophylactic hepatic arterial chemo embolization(P=0.01)and postoperative regularity of antiviral drugs(P=0.03).The results of multivariate analysis showed that the preoperative AFP concentration of>400 ug/L,the combination of cirrhosis,the combination of hepatitis b and the degree of tumor differentiation were independent risk factors for tumor recurrence after small hepatectomy(OR=1.44,1.45,3.79,1.60;95%CI=1.07~4.85,1.09~3.08,1.47~9.81,1.07~5.89;P=0.03,0.03,0.01,0.04);Regular use of antiviral drugs after operation is a protective factor for reducing recurrence of small liver cancer after operation(OR=0.41,95%Cl 0.45~0.97,P=0.04).Conclusions Surgical resection is the first choice for the treatment of small hepatocellular carcinoma.AFP>400μg/L,compl
作者
张瑞青
吐尔干艾力·阿吉
塔来提·吐尔干
张阳
邵英梅
ZHANG Rui-qing;TUERGANAILI Aji;TALAITI Tuergan;ZHANG Yang;SHAO Ying-mei(Department of Healobiliaiy and Hydatid disease,Digstive and Vascular Surgery Center,The Firt Afiliated Hospital of Xinjiang Medical University,Urimuqi,830054,China)
出处
《新疆医学》
2020年第11期1121-1124,1185,共5页
Xinjiang Medical Journal
基金
国家科技重大专项(项目编号:2018ZX10301201)
自治区重大科技专项计划子课题(项目编号:201430123-2)。
关键词
小肝癌
复发
危险因素
Small hepatocellular carcinoma
recurrence
risk factors
