169例BCLCB期肝细胞癌切除术预后因素分析

目的探讨BCLCB期肝细胞癌(hepatocellular carcinoma,HCC)患者手术切除预后的影响因素。方法收集2003年3月至2007年9月169例BCLCB期HCC手术切除患者的临床病理资料,采用Kaplan-Meier法计算术后累积生存率,以Log-rank显著性检验初步筛选出可能影响HCC预后的相关因素,应用Cox回归分析进一步明确影响预后的独立因素。结果 BCLCB期HCC患者术后1、3、5年累积生存率分别为76.3%、46.0%、38.8%。单因素分析表明术前谷丙转氨酶(ALT)、肿瘤包膜、肿瘤数目、肝硬化和术后辅助治疗影响HCC术后累计生存率(P<0.05)。多因素分析表明肿瘤包膜、肿瘤数目、肝硬化和术后辅助治疗是影响HCC术后生存率的独立因素(P<0.05)。结论手术切除是BCLCB期HCC患者有效的治疗手段,肿瘤包膜、肿瘤数目、肝硬化和术后辅助治疗是其预后的独立影响因素。

Analysis of prognostic factors in 169 patients with BCLC stage B hepatocellular carcinoma after hepatectomy

Objective To investigate prognostic factors affecting the outcomes of patients with Barcelona Clinic Liver Cancer(BCLC) stage B hepatocellular carcinoma(HCC) after hepatectomy.Methods Clinicopathologic data of 169 patients with BCLC stage B HCC were analyzed retrospectively.All patients underwent hepatectomy between March 2003 and September 2007.Cumulative sur-vival rates were calculated by the Kaplan-Meier method.Prognostic factors were screened initially by the log-rank test,and indepen-dent prognostic factors were further analyzed by Cox regression.Results Overall survival rates for 1,3,and 5 years were,respec-tively,76.3%,46.0%,and 38.8%.According to the log-rank test,preoperative serum ALT(P=0.029),tumor capsule(P=0.031),tumor num-ber(P=0.026),liver cirrhosis(P=0.027),and postoperative adjuvant therapy(P<0.001) were significantly associated with prognosis of stage B HCC,and Cox regression indicated that independent prognostic factors were tumor capsule(P=0.032),tumor number(P=0.048),liver cirrhosis(P=0.049),and postoperative adjuvant therapy(P<0.001).Conclusions Hepatectomy is an effective therapy in patients with stage B HCC,and tumor capsule,tumor number,liver cirrhosis,and postoperative adjuvant therapy are independent prog-nostic factors.