肝癌手术切除术后复发相关因素分析*

doi:10.3969/j.issn.1672-5069.2017.02.019

摘要/Abstract

摘要： 目的研究影响肝癌患者手术后复发的相关因素，为临床预测患者术后复发提供指导。方法回顾性分析我院2012年6月～2014年6月期间163例接受肝癌手术切除术患者的临床资料，随访并计算2年肿瘤复发和生存情况。收集所有患者的临床和病理学资料，应用SPSS 19.0统计学软件对相关资料进行处理，采用多因素Logistic回归分析影响肝癌患者术后复发的相关因素。结果在随访的2年中，肿瘤复发51例，未复发112例；复发患者术前存在肝硬化（80.39%）、肿瘤包膜不完整率（96.08%）、肝癌细胞分化为III和IV级比例（15.69%）、多发性肿瘤（49.02%）、多结节融合型的比例（64.71%）均明显高于未复发患者（P<0.01）；多因素Logistic回归分析显示，存在肝硬化、肿瘤包膜不完整、肿瘤细胞分化程度低、肿瘤数目多和肿瘤直径大均是导致肝癌患者术后复发的独立危险因素（P<0.05）。结论肝癌患者术后复发是多种因素造成的，可能与肿瘤大小、有无肝硬化、包膜是否完整、肝癌细胞分化程度和肝癌数目等因素有关，可用于评估患者复发的危险性，对临床早期诊断及治疗具有重要的参考价值。

关键词: 原发性肝癌, 手术切除术, 复发

Abstract: Objective To investigate the factors influencing postoperative recurrence in patients with primary liver cancer （PLC） after hepatectomy.Methods 163 patients with PLC were recruited in our hospital between June 2012 and June 2014， and they had hepatectomy and followed-up for two years. The clinical materials were retrospectively analyzed and the factors related to the recurrence of cancer after operation were evaluated by using multivariate Logistic regression analysis.Results Out of 163 patients with PLC，51 had，and 112 had not recurrence of tumor in two year follow-up period；the recurrent patients had higher percentage of underlying liver cirrhosis（80.39%），incomplete envelope of tumor （96.08%）， differentiated grade III and IV tumor cells （15.69%），multiple foci tumors（49.02%） and multiple-node fusion tumors （64.71%） than in non-recurrent patients （P<0.01）；multivariate Logistic regression analysis showed that liver cirrhosis，incomplete envelope，degree of differentiation，multiple foci and huge mass were independent risk factors for tumor recurrence after hepatectomy（P<0.05）.Conclusion HCC recurrence after resection is caused by many factors，including tumor size，liver cirrhosis，capsule integrity，differentiation degree of hepatocellular carcinoma，and multiple tumors，which might hint the risk of recurrence in patients with PLC after hepatectomy.

Key words: Primary liver cancer, Hepatectomy, Recurrence

宋书红，郭俊，邹灿. 肝癌手术切除术后复发相关因素分析*[J]. 实用肝脏病杂志, 2017, 20(2): 203-206.

Song Shuhong，Guo Jun，Zou Can.. Factors influencing postoperative recurrence in patients with primary liver cancer after hepatectomy[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2017, 20(2): 203-206.

参考文献

[1] 袁克文，王湘辉，肖毅，等. 原发性肝癌术后复发现状和影响因素分析. 检验医学与临床，2013，21（17）:2248-2249.
[2] 孙伟，李忱瑞，周纯武. 原发性肝癌术后复发影响因素的临床分析. 中国医学影像技术，2012，28（6）:1148-1151.
[3] Khoshkish S，Arefi K，Charmehali M，et al. Risk factors for postoperative recurrence of Crohn’s disease. Midd East J Dig Dis，2012，4（4）:199-205.
[4] 孙滨，张斌，张顺，等. 影响原发性肝癌术后行TACE肿瘤复发因素的分析. 中国普通外科杂志，2013，22（6）:752-755.
[5] Mathews P，Lee D，Chung Y H，et al. Effects of genomic changes in hepatitis b virus on postoperative recurrence and survival in patients with hepatocellular carcinoma. Ann Surg Oncol，2013，20（4）:1216-1222.
[6] 李彦杰，马毅，郭志勇，等. 肝癌肝移植术后复发和转移特点及预后因素分析. 中国实用外科杂志，2012，19（8）:655-658.
[7] Liao BY，Zheng W，Jie H，et al. PI-88 inhibits postoperative recurrence of hepatocellular carcinoma via disrupting the surge of heparanase after liver resection. Tumor Biol，2015，20（18）:1-12.
[8] 王学松，张庆，于德升，等. 原发性肝癌术后行肝动脉化疗栓塞治疗肿瘤复发的多因素分析. 中国现代普通外科进展，2012，15（9）:746-748.
[9] 吴孟超. 关于降低肝癌术后复发率之我见. 中国实用外科杂志，2012，22（10）:793-795.
[10] Yamashita YI，Shirabe K，Toshima T，et al. Risk factors for recurrence after curative resection of hepatitis c-related hepatocellular carcinoma in patients without postoperative interferon therapy. Hepatol Res，2013，43（12）:1313-20.
[11] 胡华华，杜凌. 原发性肝癌术后1年内复发的危险因素分析. 海南医学，2014，22（9）:1334-1336.
[12] 蔡庆，孙世波，钟锋，等. 肝癌根治性切除术后高血糖与肝癌复发的相关因素分析. 中华消化外科杂志，2016，15（1）:47-52.
[13] 张宁宁，程晓静，刘建勇，等. 大功率微波消融治疗肝癌临床疗效及其复发危险因素分析. 实用肝脏病杂志，2015，18（3）:249-253.
[14] Xieraili M，Yasen M，Mogushi K，et al. Villin 1 is a predictive factor for the recurrence of high serum alpha-fetoprotein-associated hepatocellular carcinoma after hepatectomy. Cancer Sci，2012，103（8）:1493-1501.
[15] 王文娟，白梅，蔡江涛，等. 肝脏超声造影诊断肝癌术后肝内肿瘤复发的价值探讨. 实用肝脏病杂志，2016，19（2）:214-216.
[16] Kim KA，Kim MJ，Choi JY，et al. Detection of recurrent hepatocellular carcinoma on post-operative surveillance:comparison of MDCT and gadoxetic acid-enhanced MRI. Abdom Imaging，2014，39（2）:291-299.
[17] 原强，靳勇，白旭明，等. 经肝动脉化疗栓塞联合射频消融治疗原发性肝癌及术后复发性肝癌的疗效比较及预后因素分析. 中国介入影像与治疗学，2016，11（3）:146-150.