血清前白蛋白在肝细胞癌患者肝切除术后复发风险评估中的应用

目的:分析影响肝细胞癌(HCC)患者手术后复发的危险因素,评价血清前白蛋白(PA)在预测SHCC患者术后复发中的价值。方法:选取术后病理证明为HCC,且肿瘤单发、肿瘤直径≤5 cm、无血管癌栓的143例患者资料,并进行随访。以患者术后并发症发生情况分为无并发症组和并发症组,分析相关因素及实验室指标与术后并发症的关系,采用Kaplan-Meier生存曲线分析各因素对肿瘤复发的影响。结果:与无并发症组比较,术后出现并发症组患者PA下降率较高(P<0.05),其他指标比较无明显差异(P > 0.05)。143例患者总体复发率为44.7%,1、2和3年累积复发率为29%、39%和49%,总体中位无瘤生存期(DFS)43个月。HBV-DNA<10³IU·mL^-1和HBV-DNA≥10³IU·mL^-1患者1、2、3年无瘤生存率分别为85%、77%、67%和67%、52%、47%;PA下降<43%和PA下降≥43%的患者1、2、3年无瘤生存率分别为91%、81%、64%和66%、55%、47%。结论:HBV-DNA水平和肝切除术后PA下降率是HCC患者术后复发的危险因素。在危险因素存在的条件下,HCC患者复发时间差异明显。

Application of serum prealbumin in evaluation on recurrence risk of patients with hepatocellular carcinoma after hepatectomy

Objective To analyze the risk factors associated with the recurrence in the patients with hepatocellular carcinoma (HCC), and to evaluate the value of serum prealbumin (PA) in predicting the recurrence in the patients with HCC after operation. Methods A retrospective study of the 143 patients, diagnosed by pathology with HCC after hepatectomy (solitary, tumor size≤5 cm and no metastases or major vascular invasion), was performed and the patients were divided into non-complication group and complication group by the occurrence of postoperative complication.The differences that related to tumor recurrence in two groups were evaluated using Kaplan-Meier curves. Results The patients with postoperative complications showed a higher descend rang of PA (P<0.05).The overall median disease free survival(DFS) and the rate of recurrence of 143 patients were 43 months and 44.7%, respectively. The 1-, 2-, 3- year recurrence rates of the patients after hepatectomy were 29%, 39% and 49%, respectively.The postoperative DFS rates of 1-, 2-, 3- year were 67%, 52%, and 47%, respectively, in the patients with HBV-DNA<10³IU·mL^-1, while they was 67%, 52%, and 47% in the patients with HBV-DNA≥10³IU·mL^-1.The postoperative DFS rate of 1-, 2-, 3- year were 91%, 81%, 64% respectively in the patients with PA decline <43%, while they were 66%, 55%, and 47% in the patients with decline PA≥43%. Conclusion The HBV-DNA level and the decline of postoperative PA are the risk factors of recurrence HCC of after hepatectomy.The recurrent time of the patients with HCC varies with the risk factors.