不同巴塞罗那临床肝癌Kinki分期在肝癌根治术中的应用价值

吴晓峰; 刘一纬; 张慧; 张峰; 王学浩; 李相成

doi:10.3760/cma.j.cn115610-20201102-00691

不同巴塞罗那临床肝癌Kinki分期在肝癌根治术中的应用价值

Application value of different Barcelona clinical liver cancer Kinki staging in radical resection of liver cancer

摘要

摘要: 目的:探讨不同巴塞罗那临床肝癌(BCLC)Kinki分期在肝癌根治术中的应用价值。
方法:采用回顾性病例对照研究方法。收集2017年1月至2018年10月南京医科大学第一附属医院收治的112例行根治性手术治疗BCLC B期肝癌患者的临床病理资料；男92例，女20例；中位年龄为59岁，年龄范围为21～86岁。患者均行肝癌根治术。观察指标：(1)患者临床病理特征。(2)患者随访和生存情况。(3)患者预后的影响因素分析。采用门诊和电话方式进行随访，复查甲胎蛋白(AFP)、肝功能、超声、增强CT或MRI扫描。术后1年内每3个月随访1次，术后1年后每6个月复查1次，了解患者术后生存情况。随访时间截至2020年9月。偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示，组间比较采用x²检验。采用寿命法计算生存率并采用Kaplan-Meier法绘制生存曲线，采用Log-rank 检验进行生存分析。采用COX比例风险模型进行单因素和多因素分析。
结果:(1)患者临床病理特征：112例患者中，BCLC Kinki B1期38例，BCLC Kinki B2期74例。BCLC Kinki B1期和BCLC Kinki B2期患者术前AFP(≤20 μg/L，>20 μg/L)、微血管侵犯(无，有)、肿瘤复发(无，有)分别为20、18例，25、13例，25、13例和22、49例，30、41例，22、52例，两期患者上述指标比较，差异均有统计学意义(x²=4.897、5.485、13.405，P<0.05)。(2)患者随访和生存情况：112例患者均获得随访，随访时间为2～44个月。BCLC Kinki B1期和Kinki B2期患者1、2、3年总体生存率分别为92%、86%、74%和78%、61%、45%，1、2、3年无瘤生存率分别为84%、53%、43%和35%、23%、20%，两期患者总体生存情况和无瘤生存情况比较，差异均有统计学意义(x²=7.571、15.115，P<0.05)。(3)患者预后的影响因素分析。单因素分析结果显示：患者BCLC Kinki分期、年龄、微血管侵犯和肿瘤分化程度是影响肝癌患者根治术后总体生存情况的相关因素(风险比=2.985、1.930、3.520、3.406，95%可信区间为1.318～6.763、1.023～3.642、1.714～7.230、1.571～7.385，P<0.05)；患者BCLC Kinki分期、术前AFP、微血管侵犯和肿瘤分化程度是影响肝癌患者根治术后无瘤生存情况的相关因素(风险比=2.806、2.122、2.826、2.914，95%可信区间为1.632～4.823、1.266～3.556、1.743～4.580、1.601～5.306，P<0.05)。多因素分析结果显示：患者BCLC Kinki分期、年龄、微血管侵犯和肿瘤分化程度是肝癌患者根治术后总体生存情况的独立影响因素(风险比=2.587、2.568、2.280、4.328，95%可信区间为1.036～6.462、1.215～5.429、1.011～5.141、1.677～11.171，P<0.05)；患者BCLC Kinki分期、术前AFP、微血管侵犯和肿瘤分化程度是肝癌患者根治术后无瘤生存情况的独立影响因素(风险比=2.579、1.942、2.572、2.750，95%可信区间为1.426～4.662、1.109～3.400、1.505～4.397、1.436～5.269，P<0.05)。进一步分析BCLC Kinki分期和微血管侵犯对肝癌患者预后的影响，其结果显示：BCLC Kinki B1期无微血管侵犯和有微血管侵犯患者1、2、3年总体生存率分别为96%、91%、91%和85%、75%、45%，1、2、3年无瘤生存率分别为96%、63%、48%和62%、21%、21%，两者总体生存情况和无瘤生存情况比较，差异均有统计学意义(x²=4.431、7.447，P<0.05)。
结论:BCLC Kinki分期可判断肝癌根治术后患者预后，BCLC Kinki B1期患者行根治术预后更好。

Abstract: Objective:To investigate the application value of different Barcelona clinical liver cancer (BCLC) Kinki staging in radical resection of liver cancer.
Methods:The retrospective case-control study was conducted. The clinicopathological data of 112 patients with BCLC stage B liver cancer who underwent radical resection in the First Affiliated Hospital of Nanjing Medical University from January 2017 to October 2018 were collected. There were 92 males and 20 females, aged from 21 to 86 years, with a median age of 59 years. All patients underwent radical resection of liver cancer. Observation indicators: (1) clinicopathological data of patients; (2) follow-up and survival; (3) analysis of influencing factors for prognosis of patients. Follow-up was performed through outpatient examination and telephone interview including alpha fetalprotein (AFP), liver function, ultrasonography, enhanced computed tomography or magnetic resonance imaging. The follow-up was performed once every three months within postoperative one year and once every six months thereafter to detect survival of patients up to September 2020. Measurement data with skewed distribution were represented as M (range). Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test. The life-table method was used to calculate survival rates, Kaplan-Meier method was used to draw survival curves, and Log-rank test was used for survival analysis. Univariate and multivariate analyses were conducted using the COX proportional hazard model.
Results:(1) Clinicopathological data of patients: of the 112 patients, 38 were in BCLC Kinki stage B1 and 74 were in BCLC Kinki stage B2. Cases with preoperative AFP≤20 μg/L or >20 μg/L, cases with or without microvascular invasion (MVI), cases with or without tumor recurrence in BCLC Kinki stage B1 and BCLC Kinki stage B2 patients were 20,18, 25, 13, 25, 13 and 22, 49, 30, 41, 22, 52, respectively, showing significant differences in the above indicators (x²=4.897, 5.485, 13.405, P<0.05). (2) Follow-up and survival: 112 patients were followed up for 2-44 months. The 1-, 2-, 3-year overall survival rates of patients in BCLC Kinki stage B1 and BCLC Kinki stage B2 were 92%, 86%, 74%, 78%, 61%, 45% and tumor-free survival rates were 84%, 53%, 43%, 35%, 23%, 20%, respectively. There were significant differences in the overall survival and tumor-free survival between BCLC Kinki stage B1 and B2 patients (x²=7.571, 15.115, P<0.05). (3) Analysis of influencing factors for prognosis of patients: results of univariate analysis showed that BCLC Kinki staging, age, MVI and tumor differentiation were related factors for overall survival of patients after radical resection of liver cancer ［hazzard ratio (HR)=2.985, 1.930, 3.520, 3.406, 95% confidence interval (CI) as 1.318-6.763, 1.023-3.642, 1.714-7.230, 1.571-7.385, P<0.05］; BCLC Kinki staging, preoperative AFP, MVI and tumor differentiation were related factors for tumor-free survival of patients after radical resection of liver cancer (HR=2.806, 2.122, 2.826, 2.914, 95%CI as 1.632-4.823, 1.266-3.556, 1.743-4.580, 1.601-5.306, P<0.05). Results of multivariate analysis showed that BCLC Kinki staging, age, MVI and tumor differentiation were independent influencing factors for overall survival of patients after radical resection of liver cancer (HR=2.587, 2.568, 2.280, 4.328, 95%CI as 1.036-6.462, 1.215-5.429, 1.011-5.141, 1.677-11.171, P<0.05); BCLC Kinki staging, preoperative AFP, MVI and tumor differentiation were independent influencing factors for tumor-free survival of patients after radical resection of liver cancer (HR=2.579, 1.942, 2.572, 2.750, 95%CI as 1.426-4.662, 1.109-3.400, 1.505-4.397, 1.436-5.269, P<0.05). Further analysis of influence of BCLC Kinki staging and MVI on prognosis of patients showed that the 1-, 2-, 3-year overall survival rates of patients in BCLC Kinki stage B1 without or with MVI were 96%, 91%, 91%, 85%, 75%, 45% and tumor-free survival rates were 96%, 63%, 48%, 62%, 21%, 21%, respectively, showing significant differences in the above indicators (x²=4.431, 7.447, P<0.05).
Conclusions: BCLC Kinki staging can judge the prognosis of patients after radical resection of liver cancer. BCLC Kinki stage B1 liver cancer patients have better prognosis.

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