肝细胞癌肝切除术后预后影响因素分析

目的探讨影响肝细胞癌肝切除术后预后因素，为进一步治疗及判断预后提供依据。方法回顾性分析1994年10月至1998年10月中国医学科学院肿瘤医院手术切除的230例HCC病人资料。对可能影响预后的各种因素进行单因素分析，采用逐步回归法将可能对预后有影响的指标，依次引入Cox模型进行多因素分析。结果全组1、3、5年复发率分别为35．2％、52．1％、62．4％；总的1、3、5年生存率分别为79．1％、53．7％、40．2％。单因素分析显示肿瘤最大直径是否≥5cm、有无脉管瘤栓、术前AST、肝被膜受侵、肿瘤切缘为影响对肿瘤复发和无瘤生存率有影响（P〈0．05）。多因素分析显示脉管瘤栓、术前AST升高、肿瘤切缘、肝被膜受侵及肿瘤最大直径依次为影响预后的主要因素。结论肝细胞癌的预后是由多种因素决定的，脉管瘤栓、术前AST升高、肿瘤最大直径及肝被膜受侵是影响预后的最主要因素。早期发现、早期治疗是提高肝癌病人生存率的重要途径，对存在预后不良因素的病人，应加强术后随诊，及时发现术后复发和转移。

A study on factors influencing survival of HCC patients after hepatectomy

Objective To study prognostic factors in patients with hepatocellular carcinoma (HCC) after hepatectomy. Methods The clinical data of 230 patients with HCC treated with hepatectomy in our hospital from January 1994 to December 1998 were retrospectively analyzed. The Kaplan-Meier method and Log rank test were used to determine univariate prognostic factors. The Cox proportional hazard model with stepwise selection of variables was used for multivariate analysis. Results The 1-, 3- and 5-year recurrence rates were 35.2%, 52.1% and 62.4%, and the overall 1-, 3- and 5-year survival rates were 79.1%, 53.7% and 40.2%, respectively. The univariate analysis showed that invading blood vessels or liver capsule, preoperative ascending of AST, resection margin and tumor size were statistically significant (P<0.05). The multivariate analysis indicated that blood vessel invasion, preoperative AST ascending, liver capsule invasion, resection margin and tumor size were the major risk factors affecting the prognosis. Conclusions The prognosis of HCC after curative resection is affected by multiple factors mainly including blood vessel invasion, preoperative AST ascending, liver capsule invasion, and resection margin and tumor size. Early detection, early treatment is crucial to improve the survival rate. In patients with such factors, follow-up should be enhanced to detect recurrence and metastasis.