影响肝细胞癌根治性切除术后生存5年以上患者预后的相关因素分析

发布时间：2018-06-28 19:11

本文选题：肝细胞癌 + 预后　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:探究影响HCC患者行肝部分切除术后远期生存的因素,以期能为HCC患者的临床治疗及预后评估提供理论依据。方法:回顾性分析237例术后生存时间超过5年HCC患者的临床及随访资料,选择可能影响患者预后的因素,包括:性别、年龄、肿瘤数目、肿瘤大小、BCLC、肝功能Child-pugh分级、ALT、AST、TBIL、GGT、ALB、AFP、围手术期输血、肿瘤是否复发及复发后治疗等变量。采用SPSS 22.0软件进行计算分析,Kaplan-Meier法计算患者的无瘤生存率及总体生存率,Log-rank检验进行单因素分析,多危险因素采用COX模型分析,筛选出影响HCC术后生存时间较长患者复发及远期生存的独立预后因素。结果:单因素分析提示肿瘤数目、BCLC、围手术期输血是术后生存期较长患者肿瘤复发的危险因素,差异有统计学意义(P0.05)。多因素分析提示肿瘤数目及围手术期输血是术后生存时间较长患者肿瘤复发的独立影响因素。单因素分析显示:性别、年龄、肿瘤数目、BCLC、围手术期输血、肿瘤复发后治疗方式与术后生存时间较长患者的预后相关,差异有统计学意义(P0.05)。所有被纳入本研究的患者中,有101例(42.6%)发生肿瘤复发,根据患者复发后不同的治疗方式纳入Log-rank检验,再次接受手术治疗患者的中位生存时间显著长于非手术患者(P0.05)。COX多因素回归分析显示:年龄、肿瘤数目、围手术期输血是HCC术后生存时间较长患者预后的独立影响因素,差异有统计学意义(P0.05)。结论:1、对于术后生存时间较长的HCC患者,性别、年龄、肿瘤数目、BCLC、围手术期是否输血以及肿瘤复发后治疗方式有关,其中年龄、肿瘤数目、围手术期输血是其远期生存的独立影响因素。2、术后生存时间超过5年的HCC患者复发后再次手术治疗效果显著好于非手术治疗。
[Abstract]:Objective: to explore the factors influencing the long-term survival of HCC patients after partial hepatectomy, and to provide theoretical basis for the clinical treatment and prognosis evaluation of HCC patients. Methods: the clinical and follow-up data of 237 patients with HCC whose survival time was more than 5 years after operation were analyzed retrospectively. The factors that might influence the prognosis of HCC patients were selected, including sex, age, tumor number. BCLC, Child-pugh grade of liver function, liver function and liver function. SPSS22.0 software was used to calculate the tumor-free survival rate and overall survival rate of patients by Kaplan-Meier method. The single factor analysis was performed by Log-rank test, and the multiple risk factors were analyzed by Cox model. The independent prognostic factors affecting the recurrence and long-term survival of HCC patients were screened. Results: univariate analysis showed that tumor number and perioperative blood transfusion were the risk factors of tumor recurrence in patients with long survival period (P0.05). Multivariate analysis suggested that tumor number and perioperative blood transfusion were independent factors of tumor recurrence in patients with long postoperative survival time. Univariate analysis showed that sex, age, tumor number and BCLC, perioperative blood transfusion, treatment methods after tumor recurrence and the prognosis of patients with longer survival time were significantly different (P0.05). Of all the patients enrolled in the study, 101 (42.6%) developed tumor recurrence, which was included in the Log-rank test according to the different treatment methods after recurrence. The median survival time of patients undergoing reoperation was significantly longer than that of non-operative patients (P0.05) .Cox multivariate regression analysis showed that age, tumor number and blood transfusion in perioperative period were independent factors influencing the prognosis of patients with HCC. The difference was statistically significant (P0.05). Conclusion: the sex, age, tumor number, blood transfusion during perioperative period and the treatment method after tumor recurrence are related to the survival time of HCC patients, age and tumor number. Perioperative blood transfusion was the independent factor of long-term survival. The recurrence of HCC patients with survival time of more than 5 years after operation was significantly better than that of non-operative treatment.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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