肝细胞癌微血管侵犯的危险因素分析及预后

Risk factors analysis and prognosis of the microvascular invasion of hepatocellular carcinoma

    摘要
  • 摘要: 目的:探讨影响肝细胞癌微血管侵犯的危险因素及其预后。
    方法:采用回顾性病例对照研究方法。收集2012年7月至2015年7月南方医科大学南方医院收治的220例肝细胞癌患者的临床病理资料。220例患者中，63例经肝癌根治术后病理学检查证实有微血管侵犯，157例无微血管侵犯。观察指标：(1)影响肝细胞癌患者微血管侵犯的单因素和多因素分析。(2)随访和生存情况。采用门诊和电话方式进行随访，了解患者生存和肿瘤复发情况。随访时间截至2016年7月。采用Logistic回归模型进行单因素和多因素分析。采用KaplanMeier法计算生存率和绘制生存曲线，采用Logrank检验进行生存分析。
    结果:(1)肝细胞癌患者微血管侵犯的影响因素分析：单因素分析结果显示：肿瘤最大直径、术前AFP、术前PLT是影响肝细胞癌患者微血管侵犯的相关因素(OR=4.542，1.576，3.655，95%可信区间：2.433～8.470，1.084~2.292，1.985～6.831，P<0.05)。多因素分析结果显示：肿瘤最大直径、术前AFP、术前PLT是影响肝细胞癌患者微血管侵犯的独立因素(RR=3.386，1.563,2.247，95%可信区间：1.703～6.729，1.054~ 2.318，1.135~4.451，P<0.05)。(2)随访和生存情况：220例肝细胞癌患者均获得术后随访，随访时间为 12~48个月，中位随访时间为26个月。63例有微血管侵犯患者术后1、2年总体生存率分别为77.3%、50.0%，术后1、2年无瘤生存率分别为47.3%、38.0%；157例无微血管侵犯患者术后1、2年总体生存率分别为92.4%、77.2%，术后1、2年无瘤生存率分别为74.5%、69.4%。两者上述指标比较，差异均有统计学意义(x2=10.480，19.605，14.677，18.461，P<0.05)。
    结论:肿瘤最大直径、术前AFP、术前PLT是影响肝细胞癌患者微血管侵犯的独立因素，微血管侵犯的肝细胞癌患者预后不良。

     

    Abstract: Objective:To explore the risk factors and prognosis of the microvascular invasion of hepatocellular carcinoma (HCC).
    Methods:The retrospective casecontrol study was conducted. The clinicopathological data of 220 patients with HCC who were admitted to the Nanfang Hospital of Southern Medical University from July 2012 to July 2015 were collected. Among 220 patients, 63 were confirmed with microvascular invasion of HCC by postoperative pathological examination after radical resection of HCC and 157 were not confirmed with microvascular invasion of HCC. Observation indicators: (1) univariate and multivariate analyses affecting microvascular invasion of HCC; (2) followup and survival situations. Followup using outpatient examination and telephone interview was performed to detect patients′ survival and tumor recurrence up to July 2016. The univariate and multivariate analyses were done using the Logistic regression model. The survival curve and survival rate were respectively drawn and calculated by the KaplanMeier method, and the Logrank test was used for survival analysis.
    Results:(1) Univariate and multivariate analyses affecting microvascular invasion of HCC: the results of univariate analysis showed that maximum diameter of tumor, preoperative alphafetoprotein (AFP) and preoperative platelet (PLT) were related factors affecting microvascular invasion of HCC ［OR=4.542, 1.576, 3.655, 95% confidence interval (CI): 2.433-8.470, 1.084-2.292, 1.985-6.831, P<0.05］. The results of multivariate analysis showed that maximum diameter of tumor, preoperative AFP and preoperative PLT were independent factors affecting microvascular invasion of HCC (RR=3.386,1.563, 2.247， 95%CI: 1.703-6.729,1.054-2.318, 1.135-4.451, P<0.05). (2) Followup and survival situations: 220 patients were followed up for 12-48 months, with a median time of 26 months. The postoperative overall 1 and 2year survival rates, postoperative 1 and 2year tumorfree survival rates were 77.3%, 50.0%，47.3%, 38.0% in 63 patients with microvascular invasion of HCC and 92.4%, 77.2%, 74.5%, 69.4% in 157 patients without microvascular invasion of HCC, with statistically significant differences (x2=10.480, 19.605, 14.677, 18.461, P<0.05).
    Conclusion:The maximum diameter of tumor, preoperative AFP and preoperative PLT are independent factors affecting microvascular invasion of HCC, and patients with microvascular invasion of HCC have poor clinical prognosis.

     

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