甲胎蛋白阴性肝细胞癌的临床及病理分析

发布时间：2018-03-03 19:33

本文选题：甲胎蛋白　切入点：肝细胞癌　出处：《宁夏医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的通过对比甲胎蛋白阴性肝细胞癌和甲胎蛋白阳性肝细胞癌的病例资料,分析甲胎蛋白阴性肝细胞癌的临床病理特征、预后及影响预后的因素。材料与方法收集2010年1月~2016年1月在宁夏医科大学总医院肝胆外科住院行根治性手术治疗且经病理确诊为肝细胞癌的194例患者的临床资料。根据术前AFP水平分为AFP阴性及AFP阳性两组。对比两组患者的一般资料、术前检验资料、乙肝背景、术中情况及术后病理的不同。对两组患者进行随访,对比1年、3年、5年生存率的差异,多因素分析影响AFP阴性肝细胞癌患者预后的因素。结果 1、AFP阴性肝细胞癌与AFP阳性肝细胞癌在性别、年龄、民族、住院时间、临床症状、术前ALT、AST、GGT、HBV-DNA定量、卫星灶、包膜是否完整方面均无显著性差异(P0.05)。2、AFP阴性肝细胞癌与AFP阳性肝细胞癌两组在HbsAg、肝硬化、肿瘤大小、脉管癌栓、肿瘤病理分化程度方面具有显著差异(P0.05)。3、总体的1年、3年、5年生存率为77%、62%、48%;AFP阴性组的1年、3年、5年生存率为93%、78%、67%;AFP阳性组的1年、3年、5年生存率为69%、54%、39%,两组使用Log-Rank单因素分析法,得出两组在生存时间上有显著性差异(P=0.002)。单因素分析显示肿瘤分化程度及脉管癌栓与AFP阴性肝细胞癌预后有关,多因素分析显示肿瘤分化程度、脉管癌栓不是影响预后的独立危险因素。结论:1、AFP水平与性别、年龄、民族、住院时间、临床症状、术前ALT、AST、GGT、HBV-DNA定量、卫星灶、肿瘤包膜均无关。2、AFP水平与HbsAg、肝硬化、脉管癌栓、肿瘤体积大小及组织分化程度有关。3、AFP阴性肝细胞癌患者预后好。
[Abstract]:Objective to analyze the clinicopathological features of alpha-fetoprotein negative hepatocellular carcinoma (AFP) and alpha-fetoprotein positive hepatocellular carcinoma (AFP). Materials and methods from January 2010 to January 2016, 194 patients with hepatocellular carcinoma were treated by radical operation and pathologically diagnosed as hepatocellular carcinoma, from January 2010 to January 2016 in the Department of Hepatobiliary surgery, General Hospital of Ningxia Medical University. Data. According to preoperative AFP level, the patients were divided into two groups: AFP negative group and AFP positive group. The general data of the two groups were compared. The data of preoperative examination, background of hepatitis B, intraoperative condition and postoperative pathology were different. The difference of 1-year, 3-year, 5-year survival rate was compared between the two groups. Multivariate analysis of the prognostic factors of patients with AFP negative hepatocellular carcinoma. Results 1AFP negative hepatocellular carcinoma and AFP positive hepatocellular carcinoma in sex, age, nationality, length of stay, clinical symptoms, preoperative alt ASTT GGTHBV-DNA quantitative, satellite focus. There was no significant difference in whether the capsule was intact or not. There was no significant difference between the two groups in HbsAg, liver cirrhosis, tumor size, vascular tumor thrombus, and AFP positive HCC. There were significant differences in the degree of pathological differentiation between the two groups (P < 0.05). The overall survival rates for 1, 3 and 5 years were 1 year, 3 years and 5 years survival rate of 77% 6222 and 48% AFP negative group respectively. The 5 year survival rate was 93,3 years and 5 years survival rate of 93,3 and 5 years in the AFP-positive group respectively. The Log-Rank single factor analysis was used in the two groups. The results showed that there was significant difference in survival time between the two groups. Univariate analysis showed that the degree of tumor differentiation and vascular tumor embolus were related to the prognosis of AFP negative hepatocellular carcinoma, and multivariate analysis showed the degree of tumor differentiation. Conclusion the level of AFP and sex, age, nationality, length of stay, clinical symptoms, preoperative alt ASTT GGTT HBV-DNA quantitative analysis, satellite focus, tumor capsule were not associated with HBsAg, cirrhosis, vascular tumor thrombus. The size of tumor and the degree of tissue differentiation were related to the prognosis of HCC patients with AFP negative.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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