微血管侵犯与肝细胞癌预后的关系的临床研究

发布时间：2018-03-15 00:21

  本文选题：肝癌　切入点：肝细胞癌　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：肝癌是世界范围内最常见的恶性肿瘤之一,发病率较高,且预后不佳。肝癌早期多无明显症状,因此很多患者就诊时就已经发展至肝癌晚期,失去最佳治疗时机,进一步导致了不良的预后。此外,肝癌术后易早期复发转移,是导致肝癌预后不佳的又一重要原因。影响肝癌预后的因素有很多,比如肿瘤大小、数量、分化程度、是否存在局部或远处转移等。越来越多的临床观察发现,有些小肝癌患者,尽管肿瘤很小,但是病理检查却发现已经伴有微血管侵犯,而有些大肝癌却没有检测到微血管侵犯。由此看来肝癌的恶性度和预后可能并不与肿瘤大小绝对相关,而是取决于是否有早期微血管侵犯。因此,近年来微血管侵犯对肝癌预后的影响受到极大关注,是判断肝癌生物学行为、侵袭性和预后等方面研究的热点。目的:本研究旨在通过回顾性分析我院行根治性切除的肝细胞癌患者的临床资料,进一步分析微血管侵犯对肝细胞癌预后的影响,以明确微血管侵犯在肝癌发生发展中的意义和作用,以期进一步指导临床肝癌的诊治。资料与方法:收集我科2010年至2014年行肝癌根治性手术,且术后病理证实为肝细胞癌的患者的临床资料(病史、血清化验结果、影像结果、在院治疗情况以及随访复查资料),对其进行系统的回顾性分析,分为伴微血管侵犯与不伴微血管侵犯两组,应用Kaplan-Meier生存曲线分析对比两组无瘤生存时间以及总体生存时间差异,结果采用Log-Rank方法检验。对肝硬化、肿瘤大小、数量、分化程度、年龄、肝炎感染史等危险因素进行单因素分析,分析其对肝癌预后的影响。结果:共收集病例118例,分为两组,其中伴微血管侵犯组28例(23.7%),不伴微血管侵犯组90例(76.3%);男性94例(79.6%),女性24例(20.4%),年龄20-73岁,平均年龄54岁;乙型病毒性肝炎患者94例(79.6%),丙型病毒性肝炎患者16例(13.6%),无肝炎患者8例(6.8%);伴有肝硬化患者96例(81.3%),无肝硬化患者22例(18.7);肿瘤单发的患者97例(82.2%),肿瘤多发的患者21例(17.8%);微小肝癌(肿瘤小于2cm)的患者有22例(18.6%),小肝癌(肿瘤大于2cm小于等于5cm)的患者有53例(45%),大肝癌(肿瘤大于5cm小于等于10cm)的患者有33例(28.0%),巨大肝癌(肿瘤大于10cm)的患者有10例(8.4%);肝功能Child-Pugh分级A级110例(93.2%),B级8例(6.8%);甲胎蛋白(alpha-fetoprotein,AFP)小于20ul/L的患者55例(46.6%),大于20ul/L小于400ul/L的患者31例(26.3%),大于400ul/L的患者32例(27.1%);根据我院病理科对术后病理肿瘤的分化程度(ES分级)的描述分为2组,分别为I/II级:87例(73.7%),III/IV级:31例(26.3%);根据随访患者有无术后治疗(抗病毒治疗、再次手术、TACE、射频消融、微波固化、无水酒精注射、抗肿瘤药物等)分为两组,有上述术后治疗的47例(39.8%),无术后治疗的患者71例(60.2%)。随访截止至2016年12月,伴微血管侵犯组平均存活时间为29.46±20.24个月,中位生存时间为29个月,最长存活时间为72个月,不伴微血管侵犯组的平均存活时间为37.89±19.10个月,中位生存时间为50个月,最长存活时间为78个月。伴微血管侵犯组平均无瘤生存时间为17.07±18.96个月,而不伴微血管侵犯组的平均无瘤生存时间为25.03±20.51个月。Kaplan-Meier曲线显示1、3、5年累计生存率伴微血管侵犯组跟不伴微血管侵犯组相比分别为64%vs 86.7%,38%vs 68.7%,和25%vs 35.7%,统计学差异显著。1、3、5年无瘤生存率伴微血管侵犯组跟不伴微血管侵犯组相比分别为42.8%vs 63.3%,20.8%vs 37.3%,和16.6%vs 25%,统计学差异显著。结论:微血管侵犯是影响肝癌预后的重要危险因素。伴有微血管侵犯的肝细胞癌患者的1、3、5年总体生存时间及无瘤生存时间均明显低于不伴微血管侵犯的患者。
[Abstract]:Liver cancer is one of the most common malignant tumors in the world, high incidence and poor prognosis. Early hepatocellular carcinoma without obvious symptoms, so many patients have developed to liver cancer, lose the best timing of treatment, further leads to poor prognosis. In addition, early recurrence and metastasis after liver resection is caused easily, and one important reason for poor prognosis for HCC. There are many factors affecting the prognosis of liver cancer, such as tumor size, number, degree of differentiation, the existence of local or distant metastasis. More and more clinical observation found that some small liver cancer patients, although the tumor is small, but the pathological examination found already associated with microvascular invasion, and some large hepatocellular carcinoma was not detected. Thus the microvascular invasion of malignant degree and prognosis of HCC may not be absolutely related with tumor size, but depends on whether the early microvascular invasion. This, in recent years the effect of microvascular invasion on the prognosis of liver cancer is of great concern, judging the biological behavior of HCC, the research hotspot in the field of invasiveness and prognosis. Objective: the purpose of this study is to through retrospective analysis of clinical data in our hospital underwent radical resection of hepatocellular carcinoma patients, further analyze the influence on the prognosis of liver cells cancer microvascular invasion, in order to clear the microvascular invasion on the significance and role in the development of hepatocellular carcinoma, diagnosis and treatment of liver cancer in order to guide the clinical treatment. Materials and methods: from 2010 to 2014 for liver cancer radical surgery, and postoperative pathology confirmed the clinical data of patients with hepatocellular carcinoma (the history of results the imaging results, serum tests, in the hospital treatment and follow-up data), retrospective analysis was performed on the system, divided into patients with microvascular invasion and without microvascular invasion in two groups, with Kaplan-Meier 瀛樻洸绾垮垎鏋愬�规瘮涓ょ粍鏃犵槫鐢熷瓨鏃堕棿浠ュ強妫�

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