原发性肝细胞癌术后早期转移复发的相关因素分析

目的 分析原发性肝细胞癌术后早期转移复发的相关因素.方法 对2006年1月至2015年1月行肝癌切除术且术后病理确诊为肝细胞癌的93例患者进行回顾性研究.将手术后1年内出现转移复发者纳入复发组,1年内未出现转移复发者纳入未复发组.分析性别、年龄、乙肝表面抗原、甲胎蛋白(AFP)、糖类蛋白肿瘤标志物19-9(CA19-9)、血糖、谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰胺转肽酶(GGT)、总胆红素、白蛋白、国际标准化值(INR)、凝血酶原时间(PT)、是否合并肝硬化、肝功能Child-Pugh分级、肿瘤大小、位置、数目、是否侵犯血管、包膜是否完整、病理分化程度、肝癌CLIP评分、肝癌TNM分期等23个因素对原发性肝癌术后早期转移复发的影响.结果 年龄、AFP、CA19-9、ALT、AST、GGT、总胆红素、白蛋白、INR、肿瘤大小、肿瘤包膜是否完整、肝癌CLIP评分、肝癌TNM分期等13个因素经单因素生存分析,差异均有统计学意义(P<0.05),而年龄、AFP、CA19-9、ALT、AST、GGT、总胆红素、肝癌CLIP评分、肝癌TNM分期等9个因素,差异均有显著统计学意义(P<0.01);AFP、肿瘤大小、肝癌的CLIP评分经多因素生存分析,差异均有统计学意义(P值分别为0.048、0.006和0.003).结论 年龄、CA19-9、ALT、AST、GGT、总胆红素、白蛋白、INR、肿瘤包膜是否完整、肝癌TNM分期等因素是肝癌术后早期转移复发的危险因素;AFP、肿瘤大小、肝癌的CLIP评分是肝癌切除术后早期转移复发的独立危险因素.

Analysis of risk factors contributing to early metastasis and recurrence of primary hepatocellular carcinoma after hepatactomy

Objective To analyze the related factors of early metastasis and recurrence of primary hepatocellu-lar carcinoma after hepatactomy. Methods From January 2006 to January 2015, ninety-three patients pathologically confirmed as primary liver cancer after hepatectomy were retrospectively analyzed. The patients who had metastasis and recurrence in one year after hepatectomy were divided into the recurrent group, and those who did not were divided into the non-recurrent group. Twenty-three factors including gender, age, hepatitis B surface antigen,α-fetoprotein (AFP), carbohydrate antigen 19-9 (CA19-9), blood glucose, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transferase (GGT), total bilirubin, albumin, international normalized ratio (INR), prothrombin time (PT), whether with cirrhosis, Child-Pugh grading of liver function, tumor size, tumor location, tumor number, whether tu-mor invading vessels, the completeness degree of tumor capsule, pathological differentiation degree of tumor, cancer of the liver italian program (CLIP) scoring and liver cancer tumor-node-metastasis (TNM) staging system were analyzed. Results Univariate survival analysis showed that there were differences on 13 related factors: age, AFP, CA19-9, ALT, AST, GGT, total bilirubin, albumin, INR, tumor size, the completeness degree of tumor capsule, liver cancer CLIP scoring, liver cancer TNM staging (P<0.05). There were significant differences on 9 related factors including age, AFP, CA19-9, ALT, AST, GGT, total bilirubin, liver cancer CLIP scoring, liver cancer TNM staging (P<0.01). Multivariate survival analysis showed that there were differences in AFP, liver cancer CLIP scoring, tumor size (P=0.048, P=0.006, P=0.003, respectively). Conclusion Age, CA19-9, ALT, AST, GGT, total bilirubin, albumin, INR, the completeness de-gree of tumor capsule, liver cancer TNM staging are the risk factors of early metastasis and recurrence after hepatectomy for hepatocellular carcinoma. AFP, tumor size, liver cancer CLIP scoring are the independent risk factors.