HBsAg 对胃癌肝转移患者联合切除术后生存率的影响

目的:探讨HBsAg对胃癌肝转移患者联合切除术后生存率的影响.方法:回顾性分析近10年来采用胃和肝转移灶同期切除手术的胃癌肝转移患者31例的5年系统随访资料.采用Kaplan-Meier法绘制生存曲线,Log-rank法比较生存率差异,再采用Cox风险比例模型行多因素分析.结果:31例患者中完成系统随访29例,随访率93.5％.该29例患者中,3例生存无复发,另26例均死于术后复发和转移.全组1,3,5年累积生存率分别为62.1％,22.4％,12.1％,HBsAg阳性患者(14例)1,3,5年累积生存率分别为58.4％,18.7％,8.9％,而HBsAg阴性患者(17例)分别为69.3％,27.9％,15.7％; HBsAg阴性患者术后生存状态优于HBsAg阳性患者(x2=2.119,P=0.034).多因素分析结果显示,HBsAg阳性患者术后死亡的风险是HBsAg阴性患者的1.670倍,此外,肝转移灶的大小、胃癌的手术类型也是影响术后生存的独立危险因素(RR=2.121,95％CI=1.864-2.378; RR=2.296, 95％CI=2.001-2.591).结论:HBsAg是胃癌肝转移联合切除术后影响预后的独立危险因素.因此实施此类手术时应考虑HBsAg的影响.

Influence of HBsAg state on survival rate of patients with gastric liver metastases after synchronous resection

Objective:To investigate the influence of HBsAg state on survival rate of the patients with gastric liver metastases after synchronous resection. Methods: The systematic follow-up data for 5 years of 31 patients with gastric liver metastases undergoing combined resection of the stomach and liver during recent 10 years were retrospectively analyzed.The survival curves were calculated by Kaplan-Meier method and Log-rank test was used to determine the significance of the survival rates.Multivariate analysis was performed by using Cox’s proportional hazards model. Results: Of the 31 patients,29 cases had a complete systemic follow-up,so the follow-up rate was 93.5%.In the 29 follow-up patients,3 cases survived without recurrence and 26 cases died due to disease recurrence or metastasis.The 1-,3-and 5-year cumulative survival rates for the whole group were 62.1%,22.4% and 12.1%,respectively.The 1-,3-and 5-year cumulative survival rates for the HBsAg positive patients(14 cases) were 58.4%,18.7% and 8.9%,and for the HBsAg negative patients(17 cases) were 69.3%,27.9% and 15.7%,respectively.HBsAg negative patients had better survival chance than HBsAg positive ones(χ2=2.119,P=0.034).The results of multivariate analysis indicated that the risk of death of the HBsAg positive patients after surgery was 1.670 times that of the negative ones,and in addition,the size of liver metastasis and the type of surgical procedure for gastric cancer were independent risk factors for survival(RR=2.121,95%CI=1.864–2.378;RR=2.296,95%CI=2.001–2.591). Conclusion: HBsAg is an independent prognostic factor for patients with gastric liver metastasis after synchronous resection.Therefore,HBsAg status should be taken into account when planning such operations.