基于微血管侵犯预测模型的肝细胞癌行肝切除术与肝移植术的疗效比较

发布时间：2018-04-28 00:44

本文选题：肝细胞癌 + 手术方式　；参考：《第二军医大学》2017年硕士论文

【摘要】：研究目的:原发性肝癌是世界第5大恶性肿瘤,第3大致死性肿瘤。随着人们健康意识的提高,越来越多肝细胞癌在早期发现,因此早期肝癌的治疗变得愈加重要。目前早期肝癌的治疗方式包括肝移植术、肝切除术等,两种手术方式各有特点,筛选适合的早期肝癌的手术方式将会使患者受益。研究表明微血管侵犯(MVI)是影响肝切除术和肝移植术预后较重要的危险因素,因此有无微血管侵犯可能会对不同手术方式的预后产生重要影响。为了评价MVI对手术方式的影响,本文通过分析肝切除术和肝移植术在有无MVI两组的预后差异判断适合患者最佳的手术方式,并基于术前指标预测术后肝癌MVI发生的Nomogram比较肝切除术和肝移植术的术后远期疗效差异。研究方法:1、病历资料回顾性分析了我院2008年1月至2010年12月连续的905例行肝切除术的米兰标准内乙型病毒肝炎相关的原发性肝癌患者的临床病理资料及长征医院于2001年1月至2015年12月连续的117例行肝移植术的米兰标准内乙型病毒肝炎相关的原发性肝细胞癌患者的临床病例资料。2、手术方式行肝切除术的全部患者为根治性切除,切缘至肿瘤边缘至少0.5cm,门阻断时间不超过20分钟。肝移植术至少由经验丰富的3位医师执行。3.随访所有患者术后采用电话随访或门诊随访,2年内每2个月随访一次,2年后每3个月随访一次。4.统计方法(1)通过R语言c-index验证Nomogram的正确性(2)分别在肝切除组和肝移植组验证建立生存分析和单多因素分析验证微血管侵犯高低危的临床意义(3)连续正态分布变量用均数±标准差表示,分类变量采用例数(百分比)表示。分类变量比较采用卡方检验或Fisher确切概率法,连续变量比较采用Kruskal-Wallis检验,生存曲线绘制采用Kaplan-Meier法,单因素分析采用log-rank检验,多因素分析采用cox比例风险模型,P0.05认为有统计学意义。研究结果:第一部分:1.1022例米兰标准内乙肝相关的原发性肝癌患者包括905例行肝切除术和117例行肝移植术的患者,肝移植组和肝切除组术后总体生存相似,但肝移植组术后复发率更低。2.MVI阳性组中,肝移植组的术后复发和总体生存结果均较肝切除组好3.MVI阴性组中,肝移植组的术后肿瘤复发和总体生存结果较肝切除组均无统计学差异第二部分:1.Nomogram的验证:905例肝切除组患者中,Nomogram的C-index值为0.721;肝移植组中Nomogram的C-index为0.705。2.Nomogram分组的临床意义:肝切除组和肝移植组中MVI高危组预后均教MVI低危组差。第三部分:1.建立MVI高危组和MVI低危组基本表,因临床特征有差异,进行PSM。2.PSM后MVI高危组中,肝移植组的术后复发和总体生存结果均较肝切除组好。3.PSM后MVI低危组中,肝移植组的术后复发和总体生存结果较肝切除组无统计学差异。4.多因素分析显示手术方式是影响MVI高危组患者的独立危险因素,对MVI低危组患者无显著影响。研究结论:在MVI阳性组中,肝移植术的预后要好于肝切除术,在MVI阴性组中,肝移植组和肝切除组具有相似的预后。Nomogram具有较好的预测能力,且临床意义显著。在MVI低危组中,肝切除组和肝移植组具有相似的预后,在MVI高危组中,肝移植组患者预后较好。
[Abstract]:Objective: primary liver cancer (HCC) is the fifth largest malignant tumor in the world and third roughly dead tumors. With the improvement of people's health awareness, more and more hepatocellular carcinoma are found early, so the treatment of early liver cancer is becoming more and more important. At present, the treatment methods of early liver cancer include liver transplantation, hepatectomy and so on, and the two kinds of surgical methods have their own characteristics, The screening of appropriate surgical methods for early liver cancer will benefit patients. Studies have shown that microvascular invasion (MVI) is an important risk factor affecting the prognosis of hepatectomy and liver transplantation. Therefore, whether or not microvascular invasion may have an important impact on the prognosis of different surgical methods. In order to evaluate the effect of MVI on the mode of operation, this article works Over analysis of hepatectomy and liver transplantation in the MVI two groups to determine the difference in the prognosis of the patients to determine the best way of operation, and based on preoperative indicators to predict the incidence of hepatocellular carcinoma MVI after the Nomogram comparison of hepatectomy and liver transplantation long-term effect difference. Research methods: 1, retrospective analysis of our hospital from January 2008 to 2010 Clinicopathological data of hepatitis B related primary liver cancer patients in the Milan standard of 905 consecutive cases of hepatectomy in December, and the clinical data of patients with hepatitis B related primary hepatocellular carcinoma (.2) in the Milan standard from January 2001 to December 2015 in the Milan standard from January 2001 to December 2015. All the patients undergoing hepatectomy were radical excision, cutting edge to the edge of the tumor at least 0.5cm, and the door blocking time was not more than 20 minutes. Liver transplantation was performed at least 20 minutes by 3 experienced physicians. All patients were followed up by telephone or outpatient follow-up after operation, followed up every 2 months in 2 years, and followed up every 3 months after 2 years. Statistical methods (1) verify the correctness of Nomogram through the R language c-index (2) to verify the clinical significance of survival analysis and single factor analysis in hepatectomy group and liver transplantation group, respectively, to verify the clinical significance of the high and low risk of microvascular invasion (3) continuous normal distribution variables are expressed in mean number + standard deviation, the number of classified variables is represented by the number of cases (percentage). Compared using chi square test or Fisher exact probability method, continuous variable comparison using Kruskal-Wallis test, survival curve drawing using Kaplan-Meier method, single factor analysis using log-rank test, multifactor analysis using Cox proportional hazard model, P0.05 think there is statistical significance. The first part: 1.1022 cases of hepatitis B in Milan standard The patients with primary liver cancer included 905 cases of hepatectomy and 117 cases of liver transplantation. The overall survival of the liver transplantation group and the hepatectomy group was similar, but the recurrence rate of the liver transplantation group was lower in the.2.MVI positive group. The postoperative recurrence and overall survival of the liver transplantation group were better in the 3.MVI negative group than the hepatectomy group, and the liver transplantation group was better than the liver transplantation group. There were no statistical differences between the postoperative tumor recurrence and the total survival results compared with the hepatectomy group: 1.Nomogram validation: in 905 patients with hepatectomy, the C-index value of Nomogram was 0.721; the C-index of Nomogram in the liver transplantation group was the clinical significance of the 0.705.2.Nomogram group: the prognosis of the high-risk group of MVI in the hepatectomy group and the liver transplantation group were all MV. I low risk group difference. Third: 1. to establish a high risk group of MVI and the basic table of MVI low risk group, because of the difference in clinical characteristics, in the high risk group of MVI after PSM.2.PSM, the postoperative recurrence and the overall survival result of the liver transplantation group are better than the.3.PSM in the low risk group of the hepatectomy group, and the postoperative recurrence and the overall survival results of the liver transplantation group are not statistically significant compared with the hepatectomy group. .4. multivariate analysis showed that the surgical method was an independent risk factor affecting the patients in the high risk group of MVI and had no significant influence on the patients in the low risk group of MVI. Conclusion: in the MVI positive group, the prognosis of the liver transplantation is better than that of the hepatectomy. In the MVI negative group, the prognosis of the liver transplantation group and the hepatectomy group is better than that of the hepatectomy group. In the low risk group of MVI, the hepatectomy group and the liver transplantation group have similar prognosis. In the high risk group of MVI, the patients in the liver transplantation group have a better prognosis.

【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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