影响单发肝细胞癌合并微血管侵犯患者预后相关因素分析

发布时间：2018-07-08 17:56

  本文选题：肝细胞癌 + 微血管侵犯　； 参考：《广西医科大学》2017年硕士论文

【摘要】：目的:探讨影响单发肝细胞癌合并微血管侵犯(Microvascular invasion,MVI)患者预后因素,为合并MVI肝癌患者的临床治疗及预后评估提供理论依据。方法:回顾性分析广西医科大学肿瘤医院肝胆外科2012年1月至2014年12月行肝细胞癌根治性手术切除的患者的病例资料,选取其中为单发肝癌且术后病理明确提示MVI存在的共152例患者的病例及随访资料,分析影响合并MVI的单发肝细胞癌预后的相关因素,具体包括:患者性别,年龄,谷草转氨酶,谷丙转氨酶,白蛋白,总胆红素,血小板,凝血时间,谷氨酰转肽酶,乙肝表面抗原阳性与否,肝硬化与否,肿瘤最大直径,是否破裂出血,包膜是否完整,CA199,甲胎蛋白,术中手术出血量,术后是否行TACE等共18个变量,以期为合并MVI的单发肿瘤的临床治疗及预后评估提供理论依据。采用SPSS 19.0软件进行分析,通过Kaplan-Meier法计算患者的生存率,Log-rank检验进行单因素分析,采用COX模型进行多因素分析,筛选出合并MVI单发肝癌患者预后相关影响因素。结果:随访至2016年12月31日。共有152例患者,男性132例,女性20例。患者年龄平均47.47±10.40岁,最大76岁,最小26岁。共有76例复发,23例死亡。无瘤生存中位时间16个月,总生存中位时间57个月。1、2、3年无瘤生存时间分别为58.1%、38.8%、25.7%。1、2、3年累计生存率分别为93.3%、85.8%、82.0%。单因素分析结果显示:性别,年龄,谷丙转氨酶,白蛋白,总胆红素,血小板,谷氨酰转肽酶,乙肝表面抗原阳性与否,肝硬化与否,CA199,甲胎蛋白,术后是否行TACE与合并MVI的单发肝癌预后无明显相关(P值0.05),肿瘤破裂出血,肿瘤直径5cm及术中失血量500m L是影响患者无瘤生存的相关因素,而肿瘤包膜不完整,术前AST40U/L及PT≥14S是影响患者总生存的相关因素(P值0.05)。多因素分析结果显示:术中失血500m L是影响患者无瘤生存的独立预后因素,术前AST40U/L及PT≥14S是影响患者总生存的独立预后因素。结论:对于合并MVI的单发肝癌患者,术中失血500m L是影响患者无瘤生存的独立预后因素;术前AST40U/L及PT≥14S是影响总患者生存的独立预后因素。
[Abstract]:Objective: to investigate the prognostic factors of patients with single hepatocellular carcinoma (HCC) complicated with microvascular invasion of MVI (Microvascular invasion MVI), and to provide theoretical basis for clinical treatment and prognosis evaluation of patients with MVI liver cancer. Methods: the data of patients undergoing radical resection of hepatocellular carcinoma from January 2012 to December 2014 in the Department of Hepatobiliary surgery, Cancer Hospital, Guangxi Medical University, were retrospectively analyzed. A total of 152 patients with MVI were selected and followed up. The factors influencing the prognosis of HCC with MVI were analyzed, including sex, age, glutamic oxaloacetic transaminase, and related factors, including: patient's sex, age, and aspartate aminotransferase. Alanine aminotransferase, albumin, total bilirubin, platelets, coagulation time, glutamyl transpeptidase, hepatitis B surface antigen positive or not, cirrhosis or not, maximum diameter of tumor, rupture or hemorrhage, intact capsule CA199, alpha-fetoprotein, In order to provide theoretical basis for clinical treatment and prognosis evaluation of single tumor with MVI, 18 variables, such as intraoperative bleeding volume, postoperative TACE and so on, could be provided. SPSS 19.0 software was used to analyze, the survival rate was calculated by Kaplan-Meier method and Log-rank test was used to carry out univariate analysis. Cox model was used to carry out multivariate analysis to screen the prognostic factors of patients with MVI single liver cancer. Results: all patients were followed up until December 31, 2016. There were 152 patients, 132 males and 20 females. The average age of the patients was 47.47 卤10.40 years old, the oldest was 76 years old and the youngest was 26 years old. A total of 76 cases of recurrence and 23 cases of death. The median survival time of tumor-free was 16 months, the median survival time of total survival was 57 months. The mean survival time of 3 years was 58.1 and 38.825.7.1.The cumulative 3-year survival rate was 93.35.8 and 82.0, respectively. Univariate analysis showed: sex, age, alanine aminotransferase, albumin, total bilirubin, platelets, glutamyl transpeptidase, hepatitis B surface antigen positive or not, liver cirrhosis or not CA199, alpha-fetoprotein, There was no significant correlation between TACE and prognosis of HCC with MVI after operation (P = 0. 05). Tumor rupture and hemorrhage, tumor diameter 5cm and blood loss during operation were the related factors affecting the survival of patients without tumor, but the tumor capsule was incomplete. Preoperative AST 40 U / L and PT 鈮，

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