系统免疫炎症指数联合循环肿瘤细胞评价老年非小细胞肺癌PD-1抑制剂治疗反应

目的 研究系统免疫炎症指数(SII)联合循环肿瘤细胞(CTC)评价老年非小细胞肺癌(NSCLC)程序化死亡受体(PD)-1抑制剂治疗反应。方法 2019年1至2021年9月收治的98例接受PD-1抑制剂治疗老年NSCLC患者纳为研究对象，分别比较不同基线SII及CTC水平患者治疗有效率，随访末，比较生存者与死亡者基线SII及CTC水平，绘制受试者工作特征(ROC)曲线，分析基线SII及CTC在鉴别NSCLC患者PD-1抑制剂治疗预后中的价值。结果 患者达到PD-1抑制剂治疗最佳疗效时，其SII及CTC均值均较治疗前下降，而疾病进展时，SII及CTC均值均又较最佳疗效时上升，差异具有统计学意义(P<0.05)。以患者基线SII及CTC计数均值水平作为分界点，将患者分别分为SII高水平组、SII低水平组；CTC高水平组、CTC低水平组。统计发现，SII低水平组治疗有效率显著高于SII高水平组，CTC低水平组治疗有效率显著高于CTC高水平组，差异均有统计学意义(P<0.05)。随访至2022年2月，63例患者死亡，存活组基线SII及CTC水平均显著低于死亡组(P<0.05)...     

Intravenous infusion of mesenteric lymph from severe intraperitoneal infection rats causes lung injury in healthy rats

AIM:To investigate whether mesenteric lymph from rats with severe intraperitoneal infection(SII)induces lung injury in healthy rats.METHODS:Twenty adult male specific pathogen-free Wistar rats were divided into two groups.Animals in the SII group received intraperitoneal injection of Escherichia coli(E.coli)at a dose of 0.3 mL/100 g.Control rats underwent the same procedure,but were injected with normal saline rather than E.coli.We ligated and drained the mesenteric lymphatic vessels and collected the mesenteric lymph.Mesenteric lymph collected from SII or control rats was infused intravenously into male healthy rats at a rate of 1 mL/h for 4 h.At the end of the infusion,all rats were sacrificed.Lungs were removed and examined histologically,and wet-to-dry weight(W/D)ratio and myeloperoxidase(MPO)activity were determined.Enzyme-linked immunosorbent assay(ELISA)was performed to determine the levels of the proinflammatory cytokines tumor necrosis factor(TNF)-αand interleukin(IL)-6.We performed Western blot to investigate the activation of Toll-like receptor(TLR)-4,and nuclear factor(NF)-κB p65.RESULTS:Compared with the control infusion group,there were obvious pathological changes in the SII group.The W/D ratio was significantly increased in the SII compared to control infusion group(5.86±0.06vs 5.37±0.06,P<0.01).MPO activity significantly increased in the SII infusion rats with a mean level of0.86±0.02 U/g compared to 0.18±0.05 U/g in the control group(P<0.01).The concentrations of TNF-αand IL-6 were significantly increased in the SII infusion group.The concentration of TNF-αwas significantly increased in the SII infusion rats compared to control infusion rats(2104.46±245.91 vs 1475.13±137.82pg/mL,P<0.01).The concentration of IL-6 was significantly increased in the SII infusion rats with a mean level of 50.56±2.85 pg/mL compared to 43.29±2.02 pg/mL(P<0.01).The expression levels of TLR-4(7496.68±376.43 vs 4589.02±233.16,P<0.01)and NF-κB(8722.19±323.96 vs 6498.91±338.76,P<0.01)were significantly increased in the SII infusion group compared to the control infusion group.The infusion of SII lymph,but not control lymph,caused lung injury.CONCLUSION:The results indicate that SII lymph is sufficient to induce acute lung injury.     

系统性免疫炎症指数与胃癌根治术后患者预后的相关性研究

目的基于外周血中性粒细胞、淋巴细胞和血小板计数计算系统性免疫炎症指数(SII),探讨其预测胃癌根治术后患者预后的临床价值。方法回顾性分析2012年1月1日至2015年1月1日于河北医科大学第四医院外三科行根治性手术治疗的2 273例胃癌患者资料,根据公式[SII=中性粒细胞计数(×109/L)×血小板计数(×109/L)/淋巴细胞计数(×109/L)]计算SII值。根据利用受试者操作特征曲线(ROC)确定的SII最佳临界值将患者分为高SII组和低SII组,采用卡方检验比较两组患者的临床病理特征和预后情况。采用Kaplan-Meier法绘制生存曲线,采用log-rank检验进行单因素生存分析,采用Cox比例风险回归模型进行多因素生存分析。分别绘制术前SII、病理TNM分期和两者联合预测患者预后和复发的ROC,并通过计算曲线下面积(AUC)值比较三者的预测效能。结果根据ROC确定SII的最佳临界值为589.5,高SII(SII≥589.5)组1 180例(51.91%),低SII(SII<589.5)组1 093例(48.09%)。与低SII组相比,高SII组胃癌患者的肿瘤最大径多≥...     

Systemic immune-inflammation index for predicting prognosis of colorectal cancer

AIM To investigate the clinical significance of preoperative systemic immune-inflammation index(SII) in patients with colorectal cancer(CRC). METHODS A retrospective analysis of 1383 cases with CRC was performed following radical surgery. SII was calculated with the formula SII =(P × N)/L, where P, N, and L refer to peripheral platelet, neutrophil, and lymphocyte counts, respectively. The clinicopathological features and follow-up data were evaluated to compare SII with other systemic inflammation-based prognostic indices such as the neutrophil-lymphocyte ratio(NLR) and platelet-lymphocyte ratio(PLR) in patients with CRC.RESULTS The optimal cut-off point for SII was defined as 340. The overall survival(OS) and disease-free survival(DFS) were better in patients with low NLR, PLR, and SII(P 0.05). The SII was an independent predictor of OS and DFS in multivariate analysis. The area under the receiver-operating characteristics(ROC) curve for SII(0.707) was larger than those for NLR(0.602) and PLR(0.566). In contrast to NLR and PLR, SII could effectively discriminate between the TNM subgroups. CONCLUSION SII is a more powerful tool for predicting survival outcome in patients with CRC. It might assist the identification of high-risk patients among patients with the same TNM stage.     

全身免疫炎症指数对乙型肝炎病毒相关慢加急性肝衰竭患者预后的评估价值

目的探讨全身免疫炎症指数(SII)对乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者预后的评估价值。方法回顾性分析2016年1月至2021年8月复旦大学附属华山医院诊治的HBV-ACLF患者的年龄、性别、并发症、入院后实验室检查结果和SII、终末期肝病模型(MELD)评分、MELD-Na评分和蔡尔德-皮尤改良评分(CTP评分)等临床资料。根据随访90 d时患者疾病转归分为生存组和死亡组。统计学分析采用配对样本t检验、曼-惠特尼U检验和χ2检验。采用Pearson相关分析SII与HBV-ACLF预后预测模型的相关性。采用受试者操作特征曲线下面积(AUC)分析SII、MELD评分、MELD-Na评分和CTP评分对HBV-ACLF患者预后预测的临床效能, 计算SII预测HBV-ACLF预后的最佳截断值, 采用Kaplan-Meier法进行生存分析。结果共纳入140例HBV-ACLF患者, 生存组88例, 其中男65例, 女23例, 年龄为(47.69±11.96)岁;死亡组52例, 其中男40例, 女12例, 年龄为(52.73±12.22)岁。死亡组年龄、天冬氨酸转氨酶、总胆红素、血...     

三阴乳腺癌中TIMP-1表达与临床病理及预后的相关性

目的探讨三阴乳腺癌(TNBC)中基质金属蛋白酶组织抑制因子(TIMP)-1的表达与临床病理及预后的关系。方法收集1998年9月至2011年9月入住黄河科技学院附属医院的TNBC患者术后石蜡标本99例,实时荧光定量PCR(RT-PCR)及蛋白免疫印迹试验(WB)检测TNBC及非三TNBC细胞株内的TIMP-1 mRNA及蛋白表达水平,免疫组织化学(IHC)检测TIMP-1的表达水平,并且分析TIMP-1表达水平与临床病理特征之间的关系;根据术后随访结果,Kaplan-Meier法分析TIMP-1表达水平与患者生存率之间的关系。结果 TIMP-1在TNBC细胞株内的mRNA及蛋白表达水平远远高于非TNBC细胞株(P<0.05);TIMP-1表达水平的高低与TNBC患者的肿瘤复发及是否存活有关(P<0.05),而与患者的年龄,绝经状态,肿瘤大小,淋巴结转移以及TNM分期无关(P>0.05);Kaplan-Meier生存曲线结果显示,TIMP-1高表达患者的生存时间较低表达患者显著缩短(P<0.05)。结论TIMP-1可以作为独立的预测TNBC患者不良预后的指标。     

系统免疫炎症指数对放化疗老年食管癌患者预后的预测作用

目的 探讨系统免疫炎症指数(SII)对放化疗老年食管癌患者预后的影响.方法 回顾性分析2015年5月至2018年5月吉林省肿瘤医院放化疗的328例老年食管癌患者的临床资料.根据治疗前SII分为低SII组(≤737.65)108例和高SII组(>737.65)220例.对所有患者随访,记录生存状况,多因素Cox回归分析食...     

系统免疫炎症指数与肝泡型包虫病患者预后的相关性分析

目的探讨分析系统免疫炎症指数(SII)与肝泡型包虫病患者预后的相关性分析。方法回顾性分析2015年1月—2018年12月青海大学附属医院肝胆胰外科收治的242例行肝泡型包虫病手术患者的临床资料,计算SII数值。计数资料两组间比较采用χ^2检验。相关性分析采用Spearman相关分析。应用受试者工作特征曲线(ROC曲线)确定SII的最佳临界值,Kaplan-Meier法绘制生存曲线,对两组患者的总生存时间进行分析,并用log-rank比较两组生存率差异;采用单因素和多因素Cox回归模型分析肝泡型包虫病患者预后的影响因素。结果SII与肝泡型包虫病患者术后病死率呈正相关(r=0.267,P<0.001)。应用ROC曲线确定术前SII的最佳临界值为758.92,将242例患者分为低SII组(SII≤758.92,126例)和高SII组(SII>758.92,n=116例)。低SII组与高SII组肝泡型包虫患者术后1、3、5年生存率分别为98.20%、88.47%、66.10%和90.80%、53.05%、27.40%,低SII组累积生存率>50%,平均生存时间为55.584个月(95%CI:53.550~57.617);高SII组累积生存率<50%,平均生存时间为39.384个月(95%CI:35.070~43.698),中位生存时间为43个月(95%CI:34.694~51.306),低SII组肝泡型包虫病患者生存率明显优于高SII组,两组总体生存率差异有统计学意义(χ^2=46.979,P<0.05)。单因素分析结果显示SII>758.92是肝泡型包虫病患者总体生存时间的影响因素(HR=5.907,95%CI:3.386~10.306,P=0.001);Cox多因素分析显示术前外周血SII是肝泡型包虫病患者总体生存率的独立危险因素(HR=3.507,95%CI:1.911~6.435,P=0.001)。结论术前SII水平与肝泡型包虫病患者预后有明确的相关性,可作为临床评估患者预后的指标,术前外周血SII越高,患者预后越差。     

三阴乳腺癌原发灶和转移灶中ER-α36、EpCAM、Sox2的表达及临床意义

目的探讨雌激素受体(ER)-α36、上皮细胞黏附分子(Ep CAM)、性别决定区Y框蛋白(Sox)2在三阴乳腺癌(TNBC)原发灶和转移灶中的表达及临床意义。方法 TNBC患者的石蜡标本62例,其中48例有对应的术后转移灶石蜡标本,采用免疫组织化学法检测ER-α36、Ep CAM、Sox2在48例TNBC原发灶和相应转移灶中的表达情况,分析ER-α36、Ep CAM、Sox2蛋白表达与TNBC患者临床病理特征的关系,并且分析TNBC组织中ER-α36、Ep CAM、Sox2蛋白之间的关系。结果在TNBC原发灶和转移灶中ER-α36、Sox2的高表达率差异有统计学意义(P<0.05),Ep CAM的高表达率差异无统计学意义(P>0.05)。TNBC组织中,ER-α36的高表达与淋巴结转移有关(P<0.05),Ep CAM的高表达与肿瘤的组织学分期有关(P<0.05),而Sox2的高表达与淋巴结转移和肿瘤TNM分期有关(P<0.05),Ep CAM与Sox2的表达存在正相关性(r=0.790,P<0.05)。结论 ER-α36和Sox2的高表达提示着TNBC的高侵袭性,且Ep CAM与Sox2在TNBC的侵袭转移中发挥着协同作用,ER-α36、Ep CAM、Sox2均可作为TNBC侵袭转移的潜在分子治疗靶标。     

老年三阴乳腺癌组织中MMP-9和CD147的表达及意义

目的探讨基质金属蛋白酶(MMP)-9和CD147在老年三阴乳腺癌(TNBC)中的表达及对预后的影响。方法行手术切除治疗的年龄≥60岁TNBC患者组织标本63例,51例老年乳腺纤维瘤组织,采用免疫组化方法,检测MMP-9和CD147的表达情况,并分析其与临床病理特征的相关性,通过Kaplan-Meier生存曲线法计算不同组别的老年TNBC的生存率。结果 MMP-9和CD147在老年TNBC中的表达明显高于老年乳腺纤维瘤(P<0.05);MMP-9和CD147的表达与老年TNBC肿瘤直径、病理学分级、组织学分级、淋巴转移情况以及Ki67高表达(>30%)有关(均P<0.05),而与P53的表达无关(P>0.05);34例MMP-9阳性的老年TNBC中位生存时间(OS)为28.0个月,95%CI为10.0~41.3个月,29例MMP-9阴性的老年TNBC OS为34.0个月,95%CI(12.0~49.6个月),MMP-9阳性生存率明显低于MMP-9阴性(P=0.015);37例CD147阳性的老年TNBC OS为26.0个月,95%CI为10.0~35.2个月,26例CD147阴性的老年TNBC OS为35.0个月,95%CI为11.0~51.7个月,CD147阳性生存率明显低于CD147阴性(P=0.007)。结论 MMP-9和CD147在老年TNBC中表达显著增高,且与TNBC的恶性进展密切相关,有可能成为老年TNBC临床治疗新靶点。     

全身免疫炎症指数对失代偿期肝硬化患者预后的评估价值

目的 探讨全身免疫炎症指数(systemic immune-inflammation index,SII)评估失代偿期肝硬化患者预后的价值.方法 回顾性分析2016年2月至2019年9月宜宾市第一人民医院消化内科收治的196例失代偿期肝硬化患者的临床资料.收集患者性别、年龄、病史及病因等一般人口学资料和入院后首次实验室...     

Abdominoperineal excision following preoperative radiotherapy for rectal cancer: Unfavorable prognosis even with negative circumferential resection margin

AIM: To evaluate whether an abdominoperineal excision (APE) is associated with increased local recurrence (LR) and shortened disease-free survival (DFS) in mid-low rectal cancer with a negative circumferential resection margin (CRM).METHODS: 283 consecutive cases of mid-low rectal cancer underwent preoperative 30 Gy/10 F radiotherapy and surgery in Peking University Cancer Hospital between August 2003 and August 2009. Patients with positive CRM and intraoperative distant metastasis were precluded according to exclusion criteria. Survival analyses were performed in patients with APE or non-APE procedures.RESULTS: 256 of the 283 (90.5%) cases were enrolled in the analysis, including 78 (30.5%) and 178 (69.5%) cases who received APE and non-APE procedures. Fewer female patients (P = 0.016), lower level of tumor (P = 0.000) and higher body mass index (P = 0.006) were found in the APE group. On univariate analysis, the APE group had a higher LR rate (5.1% vs 1.1%, P = 0.036) and decreased DFS (73.1% vs 83.4%, P = 0.021). On multivariate analysis, APE procedure was also an independent risk factor for LR (HR = 5.960, 1.085-32.728, P = 0.040) and decreased DFS (HR = 2.304, 1.298-4.092, P = 0.004). In stratified analysis for lower rectal cancer, APE procedure was still an independent risk factor for higher LR rate (5.6% vs 0%, P = 0.024) and shortened DFS (91.5% vs 73.6%, P = 0.002).CONCLUSION: Following preoperative 30 Gy/10 F radiotherapy, APE procedure was still a predictor for LR and decreased DFS even with negative CRM. More intensive preoperative treatment should be planned for the candidates who are scheduled to receive APE with optimal imaging assessment.     

新辅助治疗反应对局部进展期直肠癌患者预后的影响

目的探究新辅助治疗反应对局部进展期直肠癌患者远期预后的影响。 方法回顾性收集中国医学科学院肿瘤医院218例接受术前新辅助放化疗的局部进展期直肠癌患者（LARC）的临床病理资料。根据Dowrak/R?del肿瘤退缩分级（TRG）标准将患者分为治疗反应良好（TRG3~4）和治疗反应不佳（TRG0~2）。采用Cox风险比例回归单因素和多因素分析确定无病生存（disease-free survival,DFS）和肿瘤总生存（overall survival,OS）影响因素。采用Kaplan-Meier法绘制生存曲线并利用Log-rank检验比较肿瘤生存差异。 结果本研究纳入患者218例,其中治疗反应良好126例,治疗反应不佳92例。单因素和多因素Cox回归分析确定新辅助治疗反应不佳是DFS（HR=3.85,95%CI：1.40~10.60;P=0.009）和OS（HR=3.81,95%CI：1.02~14.20;P=0.046）的独立危险因素。5年DFS分别为反应良好93.46%,反应不佳65.04%（χ²=28.23,P＜0.001）;5年OS分别为反应良好95.38%,反应不佳78.99%（χ²=18.51,P＜0.001）。 结论新辅助治疗反应是LARC患者DFS和OS的独立预后因素;良好的治疗反应预示着更好的肿瘤学预后,为进一步的临床研究风险分层提供了理论基础。     

Prediction and prognostic factors of post-recurrence survival in recurred patients with early-stage NSCLC who underwent complete resection

Background

This study aimed to evaluate prognostic factors of post-recurrence survival (PRS) and to improve survival in recurred patients with early-stage non-small cell lung cancer (NSCLC).

Methods

The 141 patients with recurrence after complete resection of stage I and II NSCLC between 1995 and 2012 was retrospectively reviewed. Overall PRS and PRS of the patient groups stratified according to the sum of their own risk scores were analyzed.

Results

The patterns of recurrence of 141 patients included local only in 40(28.4%), distant only in 86 (61%) and both in 15 (10.6%) patients. Of 141 patients, 110 patients received post-recurrence therapy. The overall 1- and 3-year PRS rates were 50.7% and 28.4%, respectively. Extensive pulmonary resection (P=0.001), poor histologic differentiation (P=0.009), symptom at initial recurrence (P=0.000), no pulmonary metastasis (P=0.006), no post-recurrence therapy (P=0.001) were significant risk factors in univariate analysis. Multivariate analysis revealed that extent of pulmonary resection [hazard ratio (HR), 2.039; 95% confidence interval (CI), 1.281 to 3.244; P=0.003; risk score 1.0], histologic differentiation HR, 3.125; 95% CI, 1.976 to 4.941; P=0.000; risk score 1.5), symptom (HR, 3.154; 95% CI, 2.000 to 4.972; P=0.000; risk score 1.5) and post-recurrence therapy (HR, 2.330; 95% CI, 1.393 to 3.899; P=0.001; risk score 1.1) were significant prognostic factors. The recurred patients whose risk score sums were 1.1 or less were assigned to Group I; between 1.5 and 2.1, to Group II; and more than 2.5, to Group III. Significant differences in their PRS rates were confirmed (P=0.000).

Conclusions

Extent of pulmonary resection, histologic differentiation, symptom and post-recurrence therapy are a prognostic factor for PRS. Based on the hazard ratios of each factors, the risk scores were yielded. And the recurred patients were stratified according to the sum of their risk scores based on their PRS rates. Therefore, these results may help advancements in making predictions for their prognosis and the improvement of PRS.     

70岁及以上胃癌患者的临床病理特征及预后分析

目的:探讨≥70岁胃癌患者的临床病理特征和影响预后的危险因素。方法:回顾性分析河北医科大学第四医院外三科自2012年1月至2015年1月行根治性手术治疗的2386例胃癌患者,筛选出年龄≥70岁的患者,分析临床特征及影响预后的因素。结果:2386例胃癌患者中年龄≥70岁者342例(14.3%)。两组之间在性别、伴发疾病个...     

The significance of systematic lymph node dissection in surgery for early-stage non-small cell lung cancer patients aged ≤40 years

BackgroundSurgery remains the best option for treating early-stage non-small cell lung cancer (NSCLC), and lymph node dissection (LND) is an important step in this approach. However, the extent of LND in the general age population, especially in young patients, is controversial. This retrospective study aimed to investigate the correlation between systematic lymph node dissection (SLND) and prognosis in young (≤40 years) patients with stage IA NSCLC.MethodsClinicopathological data of 191 patients aged ≤40 years who underwent surgical pulmonary resection for stage IA NSCLC between January 2010 and December 2016 were retrospectively collected. Of the patients, 104 received SLND (SLND group), while the other 87 patients underwent sampling or no LND (non-SLND group). The disease-free survival (DFS) and overall survival (OS) curves of the patients from each group were plotted using the Kaplan-Meier method, and the correlations of the patients’ clinical factors with prognosis were also analyzed.ResultsThe median follow-up period was 55 months. During follow-up, 7 patients died, and recurrence or metastasis was detected in 16 patients. Kaplan-Meier analysis revealed no difference in DFS (P=0.132) between the SLND and non-SLND group, but a significant difference was found between the groups in OS (P=0.022). Additionally, there was no statistically pronounced difference in OS or DFS between male and female patients. Multivariate survival analysis showed that the type of SLND, as well as tumor size, is an independent prognostic factor for DFS (HR, 3.530; 95% CI, 1.120–11.119; P=0.031) and OS (HR, 13.076; 95% CI, 1.209–141.443; P=0.034).ConclusionsFor young (age ≤40) stage IA NSCLC patients with pathological invasive adenocarcinoma, intraoperative SLND can improve the DFS and OS. Further studies are needed to verify the most optimal degree of LND in young patients.     

结直肠癌肺转移患者临床特征及预后影响因素分析——基于SEER数据库的回顾性研究

目的分析初诊结直肠癌肺转移患者的临床特点,探讨影响结直肠癌肺转移发生和影响预后的预测因素。 方法通过SEER*Stat软件收集SEER数据库中2010至2013年的4 202例结直肠癌器官转移的患者。通过卡方检验和二元逻辑回归的方法比较肺转移组（894例）和非肺转移组（3 308例）各临床病理特征的差异。采用Kaplan-Meier法对影响肺转移组预后的各临床病理因素进行单因素分析;通过Log-Rank法检验生存率的差别;通过多因素Cox回归模型以得到影响结直肠癌肺转移远期存活的独立危险因素。 结果卡方检验中两组差异有统计学意义的因素包括：种族、性别、原发部位、T分期及N分期。二元逻辑回归结果显示,种族（OR：1.211,95%CI：1.040~1.411,P=0.014）、性别（OR：1.209,95%CI：1.042~1.403,P=0.013）、原发部位（OR：1.147,95%CI：1.067~1.234,P<0.001）、N分期（OR：0.907,95%CI：0.826~0.995,P=0.039）分别为肺转移发生的独立影响因素。894例直肠癌肺转移患者的中位生存时间为11个月,1年生存率为65.2%,3年生存率为24.4%。单因素生存分析显示：诊断年龄、原发部位、组织学分级、T分期、N分期、放疗情况、CEA、淋巴结检出数及其他器官转移与患者生存情况有显著的相关性。Cox比例风险模型分析显示：诊断年龄（HR：1.631,95%CI：1.344~1.980,P<0.001）、组织学分级（HR：1.405,95%CI：1.194~1.652,P<0.001）、N分期（HR：1.253,95%CI：1.111~1.414,P<0.001）、CEA（HR：1.744,95%CI：1.306~2.330,P<0.001）、淋巴结检出数（HR：1.764,95%CI：1.408~2.208,P<0.001）及其他器官转移（HR：1.980,95%CI：1.578~2.483,P<0.001）是结直肠癌肺转移患者预后的独立影响因素。 结论种族、性别、原发部位、N分期分别为预测结直肠癌肺转移发生的高危因素。诊断年龄、组织学分级、N分期、CEA、淋巴结检出数及其他器官转移是结直肠癌肺转移患者预后的独立影响因素。     

Prognostic significance of preoperative prognostic nutritional index in hepatocellular carcinoma: a meta-analysis

Background

To date, epidemiological evidence of the association between preoperative prognostic nutritional index (PNI) and the prognosis of hepatocellular carcinoma (HCC) remains controversial.

超声引导下经皮射频消融治疗小肝癌患者疗效及预后分析*

目的 比较超声引导下经皮射频消融与肝切除术治疗小肝癌患者的疗效及分析影响生存的危险因素。方法 2011年1月~2015年4月在我院接受治疗的107例肝细胞癌（HCC）患者,接受超声引导下射频消融治疗58例,接受肝叶切除术治疗49例。术后随访3年,采用Cox单因素和多因素回归分析影响HCC患者生存的独立危险因素。结果 治疗后,射频消融患者血清ALT水平显著低于肝切除术组（P<0.05）,而血清ALB水平显著高于肝切除术组（P<0.05）;两组术后并发症发生率（10.3%对16.3%）比较,差异无统计学意义（P>0.05）;射频消融治疗患者1 a、2 a和3 a总生存率分别为84.5%（49/58）、65.5%（38/58）和44.8%（26/58）,而肝切除术组则分别为85.7%（42/49）、67.3%（33/49）和46.9%（23/49）,差异不具有统计学意义（x²=0.032,P=0.859;x²=0.040,P=0.842;x²=0.048,P=0.827）; Cox单因素分析结果显示肿瘤数目（HR=0.372,95%CI:0.105~0.876,P=0.033）与HCC患者无瘤生存时间有关,而血清AFP水平（HR=3.043,95%CI:1.007~5.248,P=0.035）、肿瘤数目（HR=0.871,95%CI:0.344~0.902,P=0.401）和肿瘤直径（HR=1.631,95%CI:1.273~3.045,P=0.005）与HCC患者总生存时间有关;Cox多因素回归分析结果显示肿瘤数目多（HR=0.087,95%CI:0.045~0.498,P=0.009）是影响HCC患者无瘤生存的独立危险因素,而肿瘤分化低（HR=2.974,95%CI:1.865~4.097,P=0.046）、肿瘤数目多（HR=0.062,95%CI:0.033~0.378,P=0.002）和肿瘤直径大（HR=2.216,95%CI:1.778~5.026,P=0.007）是影响HCC患者总生存时间的独立危险因素。结论 超声引导下经皮射频消融治疗与肝切除术治疗小肝癌患者的临床疗效相当,但射频消融治疗创伤小,术后恢复快,对肝功能的影响小。