复发性肝癌再切除术患者预后因素分析

目的:探讨影响复发性肝癌再切除术的预后因素。方法:回顾性分析41例行再切除术复发性肝癌患者的临床病理资料及随访记录，采用Kaplan-Meier 和Log-rank 对数秩检验对23个临床病理因素进行单因素分析，然后引入Cox 比例风险模型进行多因素分析。另外，对各次术中失血量及手术时间采用单因素方差分析进行比较。结果:再次手术后患者1、3、5 年生存率分别为68% 、36% 、35% ，无瘤生存率分别为39% 、22% 、7% 。影响生存期的独立预后因素为:第1 次手术时门静脉癌栓形成、第1 次手术时肝硬化结节直径大小、第2 次手术切缘距离、第2 次手术后辅助治疗。未得出影响无瘤生存期的独立预后因素。各次术中失血量及手术时间无显著性差异。结论:第1 次手术中合并门静脉癌栓或硬化结节直径较大的患者，行再切除术预后差。第2 次手术中肝切缘距离>1cm或者术后辅以其他综合治疗可以改善患者预后。 

Prognostic Factors of Patients with Recurrent Hepatocellular Carcinoma after Re-excision

Objective: To discuss the prognostic factors of patients with recurrent hepatocellular carcinoma following the second resection of cancer. Methods:Clinico-pathologic data and follow-up records of 41 patients with recurrent hepato-cellular carcinoma, who underwent re-excision, were retrospectively reviewed in this study. Kaplan-Meier curve and log-rank test were used for univariate analysis of the 23clinico-pathologic variables, and then multivariate analysis was conducted using the COX proportional hazard regression model. In addition, the one-factor analysis of variance was conducted to compare the amount of blood loss and the time of surgery in the surgical procedures. Results: The 1-, 3- and 5-year overall survival rates of the 41 patients undergoing the second excision of cancer were 68% ,36% and35% , respectively, while the 1-, 3- and 5-year disease-free survival rates of the patients were 39% ,22% and 7% , respectively. The independent prognostic factors affecting the survival rates include: (i) portal vein tumor thrombus in the first hepatectomy; (ii) diameter of the liver cirrhosis nodule in the first hepatectomy; (iii) the scope of surgical margin in the second hepatectomy, and (iv) postoperative adjuvant therapy after re-excision. No independent prognostic factor influencing the recurrence-free survival rates was obtained. There were no significant differences in the intra-operative blood loss amount and the operation time among the surgical procedures. Conclusion : The prognosis after re-excision is poor in patients with portal vein tumor thrombus or bigger diameter of the cirrhosis nodule in the first surgery. In the second surgery, the scope of the surgical margin of liver over 1cm or postoperative adjuvant combined therapy may improve the prognosis of the patients.