摘要
目的探索肝细胞癌(hepatocellular carcinoma,HCC)患者术后早期复发的危险因素并初步建立预测模型,评估患者生存预后。方法纳入2015年1月-2019年1月期间自贡市第一人民医院肝胆外科收治的肝细胞癌患者176例,平均年龄为56.31±7.38岁。根据1年内有无复发,分为早期复发组和非早期复发组,先纳入年龄、性别、TNM分期、病理分化程度等17个因素进行独立危险因素分析,然后根据筛选的独立危险因素建立早期复发模型,绘制总生存曲线图,并进一步评估各独立因素与总生存曲线的相关性。结果(1)术后早期复发者105例被纳入早期复发组,余71例为非早期复发组,早期复发率为59.7%。高甲胎蛋白(Alpha⁃fetoprotein,AFP)、病灶多灶、肿瘤最大径>5cm、门静脉癌栓、病理低分化程度是影响肝癌术后早期复发的独立危险因素(P<0.05)。(2)术后早期复发预测模型为Probit(P)=0.196∗AFP+0.182∗病灶数量+0.210∗肿瘤最大直径+0.257∗门静脉癌栓+0.286∗分化程度-0.072(R^(2)=0.237,F=11.851,P=0.000),分化程度的标准化回归系数最大且为0.286。(3)随访时间3~72个月,中位生存期60.00±6.41个月,且AFP>400ng/mL、病灶多发、肿瘤最大径>5cm、门静脉癌栓形成、病理类型低分化的HCC患者术后中位生存期均显著低于AFP≤400ng/mL、病灶单发、肿瘤最大径≤5cm、无门静脉癌栓、高-中分化病理类型的HCC患者(均P<0.05)。结论术前AFP、病灶数量、肿瘤最大径、门静脉癌栓、病理分化程度是肝癌术后早期复发的独立危险因素。
Objective To explore the risk factors of early postoperative recurrence of hepatocellular carcinoma(HCC)and es⁃tablish a preliminary prediction model to evaluate the overall survival and prognosis of patients.Methods 176 patients with primary liver cancer admitted to the Department of Hepatobiliary Surgery,Zigong First People's Hospital,from January 2015 to January 2019 were selected,and these patients have an average age of 56.31±7.38 years old.According to whether there is recurrence within 1 year,these patients were divided into early recurrence group and non⁃early recurrence group.Firstly,19 factors such as age,sex,TNM stage,and pathological differentiation degree were included for independent risk factor analysis,and then an early recurrence model was established according to the screened independent risk factors.Finally,the overall survival curve was drawn,and the corre⁃lation between each independent factor and the overall survival curve was further evaluated.Results(1)105 cases of early postoper⁃ative recurrence of HCC were included in the early recurrence group,and the remaining 71 cases were not in the early recurrence group,with an early recurrence rate of 59.7%.High alpha⁃fetoprotein(AFP),multiple lesions,maximum tumor diameter>5cm,positive portal vein thrombus,and poor pathological differentiation were independent risk factors for early recurrence of liver cancer af⁃ter surgery(P<0.05).(2)The prediction model of early postoperative recurrence was Probit(P)=0.196AFP+0.182number of le⁃sions+0.210maximumtumor diameter+0.257portal vein thrombus+0.286degree of differentiation-0.072,(R^(2)=0.237,F=11.851,P=0.000).The standardized regression coefficient of the degree of differentiation was 0.286 and was the largest.(3)Fol⁃low⁃up time ranged from 3 to 72 months.The median total survival time was 60.00±6.41 months.The median total survival time of HCC patients with AFP>400ng/mL,multiple lesions,maximum tumor diameter>5cm,positive portal vein thrombosis,and poorly differentiated pathologica
作者
唐兵
李晓东
黄河
TANG Bing;LI Xiao-dong;HUANG He(Department of Hepatobiliary Surgery,Zigong First People's Hospital;Otolaryngology,Zigong First People's Hospital,Zigong 643000,China)
出处
《肝胆外科杂志》
2022年第3期199-204,共6页
Journal of Hepatobiliary Surgery
关键词
肝细胞癌
肝癌切除术
早期复发
hepatocellular carcinoma
hepatectomy
early recurrence
