肥胖对肝癌术后预后的影响的临床研究

发布时间：2018-05-29 02:31

  本文选题：肥胖 + 肝细胞肝癌　； 参考：《吉林大学》2017年硕士论文

【摘要】：目的:本研究旨在系统分析肥胖是否作为一种独立的危险因素影响肝癌患者手术后的预后,包括近期并发症、无瘤生存时间、总生存时间及生存率。进一步探讨分析合理减肥在降低肝癌的发生,延缓肝癌的进展以及改善肝癌的预后等方面的作用与意义。方法:回顾性分析吉林大学中日联谊医院肝胆胰外科2010年1月至2014年12月间118例行根治性手术切除的肝癌患者的临床资料。根据体重指数(body mass index,BMI),将研究对象分为肥胖和非肥胖两组。肥胖组共41例,其中男性32例,女性9例;非肥胖组共77例,其中男性62例,女性15例。将两组肝癌患者的一般因素及术后资料分别进行T检验、卡方检验或Mann-Whitney U检验,绘制Kaplan-Meier生存曲线,进行Log-Rank检验。对比分析两组患者术后并发症的发生率、无瘤生存时间、总生存时间、无瘤生存率及总生存率并进行统计学分析。结果:肥胖组与非肥胖组相比,术后并发症的发生率分别是17.1%vs20.8%(p0.05);术后平均无瘤生存时间分别是16.01个月vs 25.49个月(p0.05);中位无瘤生存时间分别为9个月vs 24个月(p0.05);术后总生存时间分别为28.27±17.91个月vs 36.37±19.30个月(p0.05);中位生存时间分别为26个月vs 37个月(p0.05);术后1、2、3、4、5年无瘤生存率,肥胖组与非肥胖组相比较分别为:34.1%vs 66.2%(p0.05),24.4%vs 51.9%(p0.05),22.6%vs 31.7%(p0.05),19.2%vs 30.2%(p0.05),16.7%vs 28.6%(p0.05);术后1~5年总生存率肥胖组与非肥胖组比较分别为:82.9%vs 89.6%(p0.05),58.5%vs 77.9%(p0.05),32.3%vs 65.1%(p0.05),26.9%vs 53.5%(p0.05),25.0%vs 42.9%(p0.05)。肥胖组的术后无瘤生存时间、总生存时间、1~2年无瘤生存率及2~4年总生存率明显低于非肥胖组(P0.05),有统计学意义,而两组之间的术后并发症发生率、3~5年无瘤生存率及1年、5年总生存率无明显统计学差异(P0.05)。而两组的Kaplan-Meier生存曲线,经过Log Rank检验,P0.05,统计学差异显著。单因素分析结果显示:肿瘤大小、肿瘤数量、AFP、分化分级、微血管侵犯及BMI影响患者手术切除后的复发;肿瘤大小、肿瘤数量、分化分级、微血管侵犯及BMI影响患者术后的生存。Cox多因素分析显示:肿瘤分化分级、微血管侵犯及BMI是肝癌患者手术切除后复发的独立危险因素,而肿瘤大小、肿瘤数量、微血管侵犯及BMI是生存的独立危险因素。结论:肥胖患者肝癌术后的无瘤生存时间、总生存时间、无瘤生存率及总生存率均明显低于非肥胖患者。说明,肥胖可促进肝癌的发展,缩短肝癌术后的无瘤生存时间及总生存时间,是影响肝癌预后的独立危险因素。
[Abstract]:Objective: to systematically analyze whether obesity is an independent risk factor affecting the prognosis of patients with liver cancer, including recent complications, tumor-free survival time, total survival time and survival rate. To further explore the role and significance of reasonable weight loss in reducing the occurrence of liver cancer, delaying the progress of liver cancer and improving the prognosis of liver cancer. Methods: the clinical data of 118 patients with hepatobiliary and pancreatic cancer underwent radical resection from January 2010 to December 2014 were analyzed retrospectively. The subjects were divided into obese group and non obese group according to body mass index (BMI). There were 41 cases in obesity group, 32 cases in male and 9 cases in female, and 77 cases in non-obesity group, among which 62 cases were male and 15 cases were female. The general factors and postoperative data of the two groups of patients with liver cancer were examined by T test, chi-square test or Mann-Whitney U test, Kaplan-Meier survival curve was drawn and Log-Rank test was performed. The incidence of postoperative complications, tumor-free survival time, total survival time, tumor-free survival rate and overall survival rate were analyzed statistically. Results: the obese group compared with the non-obese group, The incidences of postoperative complications were 17.1vs20.8 and 16.01 months vs 25.49 months respectively, the median survival time was 9 months vs 24 months, and the total survival time was 28.27 卤17.91 months vs 36.37 卤19.30 months, respectively. The median survival time was 26 months vs 37 months, respectively. 鑲ヨ儢缁勪笌闈炶偉鑳栫粍鐩告瘮杈冨垎鍒�涓�:34.1%vs 66.2%(p0.05),24.4%vs 51.9%(p0.05),22.6%vs 31.7%(p0.05),19.2%vs 30.2%(p0.05),16.7%vs 28.6%(p0.05);鏈�鍚�1~5骞存，

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