原发性肝细胞癌行根治性肝切除术后复发的预后因素分析

目的 探讨原发性肝细胞癌(hepatocellular carcinoma,HCC)行根治性肝切除术后影响复发的预后因素.方法 回顾性分析2002年1月至2009年1月间行根治性肝切除术治疗的101例HCC患者的临床资料.应用Cox比例风险模型行单因素和多因素分析.Kaplan-Meier法计算术后复发时间,做Log-rank检验.应用受试者工作特征曲线评估预后因素预测能力,并做风险等级划分.结果 至随访截止,75例出现术后复发.早期复发(≤2年)63例(84.0%),晚期复发(＞2年)12例(16.0%).总体1、2、3、5年累积复发率分别为48.5%(49/101)、62.4%(63/101)、70.3%(71/101)、74.3%(75/101).多因素分析显示切缘肿瘤细胞阳性、巴塞罗那肝癌中心(BCLC)分级和肝硬化程度是HCC术后早期复发的影响因素,不同风险等级术后早期复发率的差异有统计学意义(χ2=29.198,P:0.000).年龄≥60岁和肿瘤包膜形成是HCC术后晚期复发的影响因素,不同风险等级术后晚期复发率的差异有统计学意义(χ2=8.479,P=0.004).结论 HCC行根治性肝切除术后早期复发和晚期复发的影响因素不同.切缘肿瘤细胞阳性、BCLC分级和肝硬化程度影响术后早期复发,而年龄≥60岁和肿瘤包膜形成是术后晚期复发的影响因素.预后因素等级划分有助于预测HCC患者术后复发.

Different prognostic factors are associated with early and late intrahepatic recurrence following curative hepatectomy for patients with hepatocellular carcinoma

Objective To investigate prognostic factors related to early and late intrahepatic recurrences after curative hepatectomy for patients with hepatocellular carcinoma(HCC).Methods A retrospective review was conducted on medical records of patients with HCC treated by curative hepatectomy from January 2002 to January 2009.Clinicopathologic data were evaluated for their possible association with postoperative intrahepatic recurrence in univariate and multivariate analysis using Cox proportional hazard model.Recurrence time calculated by Kaplan-Meier method was compared using Log-rank test. Receiver operator characteristic curve(ROC)analysis with calculation of the area under the curve(AUC),sensitivity,and specificity where appropriated and risk stratification were applied to assess predictive ability of prognostic factors.Results All 101 patients underwent curative hepatectomy.During follow-up period,75 patients developed postoperative intrabepatic recurrence,among whom,63 experienced early recurrence(84.0%)and the remaining had late recurrence(16.0%).The 1-,2-,3-and 5-year cumulative recurrent rates were 48.5%(49/101),62.4%(63/101),70.3%(71/101)and 74.3%(75/101),respectively.Multivariate analysis identified that tumor residual resectional margin,increased BCLC staging and severity of concomitant liver cirrhosis as independent prognostic factors predicting early recurrence while age≥60 years and presence of tumor capsule predicting late recurrence.Cutoff point values(PI≥2.798)predicted early recurrence with AUC 0.897(95%CI=0.829-0.965).sensitivity 76.6%and specificity 88.9%calculated from ROC.Median recurrent time of early recurrence and late recurrence reached statistically difference after risk stratification,20.2 months vs.4.4 months(χ2=29.198,P=0.000),46.6 months vs.28.6 months (Log-rank test,χ2=8.479,P=0.004),respectively.Conclusions Postoperative recurrence for HCC after curative hepatectomy should be differentiated as early recurrence and late recurrence,since each is associated with different risk factors,indicating possible different mechanism responsible for postoperative recurrence.Risk stratification can be used for prediction of different type of recurrence.