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目的 探讨影响肝细胞肝癌手术切除长期生存的预后相关因素。方法 1964～1993年中山大学肿瘤防治中心经手术切除的522例肝细胞肝癌病人，随访至2003年1月，对随访结果进行回顾性分析，计算生存率并作单因素及多因素分析。结果 术后3、5、10和15年累积生存率分别为49．1％、33．8％、16．7％和13．7％；生存5年以上182例，生存10年以上56例，生存15年以上16例。单因素分析结果表明，预后影响因素为性别、术前肝功能Child-Pugh分级、GGT水平、术中肝硬化程度、肿瘤大小、肿瘤数目、有无癌栓、有无卫星结节和是否根治性切除；多因素分析得出影响术后长期生存的预后因素为术前肝功能Child-Pugh分级、GGT水平、术中肝硬化程度、肿瘤大小、有无癌栓和是否根治性切除。结论 肝癌切除术后病人长期生存与否取决于肝病背景、肿瘤情况和治疗因素。术前肝功能Child-PughA级、GGT正常、无或伴轻度肝硬化、肿瘤≤5cm、无癌栓以及行根治性切除的肝癌病人可能获得长期生存。

Prognostic factors for long-term survival after resection of hepatocellular carcinoma

Objective To investigate the prognostic factors affecting long-term survival after resection of hepatocellular carcinoma (HCC). Methods Five hundreds and twenty-two patients with HCC who underwent hepatectomy from 1964 to 1993 were followed up to January 2003 and reviewed retrospectively. The factors affecting long-term survival were studied by univariate and multivariate analysis. Results The overall 3-year, 5-year, 10-year, and 15-year survival rates were 49.1%, 33.8%, 16.7% and 13.7%, respectively. One hundred and eighty-two patients survived more than 5 years. Fivty-six patients survived more than 10 years.Sixteen patients survived more than 15 years. Univariate analysis showed that sex, Child-Pugh class, GGT level, degree of accompanying cirrhosis, tumor size, number of tumors, tumor thrombus, satellite nodule and radical resection were significant prognostic factors. The use of Cox s multivariate proportional hazard model indicated that significant prognostic factors for long-term survival were Child-Pugh class, GGT level, degree of accompanying cirrhosis, tumor size, tumor thrombus and radical resection. Conclusion Factors affecting long-term survival were Child-Pugh class, GGT level, degree of accompanying cirrhosis, tumor size, tumor thrombus and radical resection, which can be concluded to three aspects, i.e., hepatopathy background, tumor factors and treatment factors. Liver function Child-Pugh A, normal GGT level, without cirrhosis or accompanying mild cirrhosis, tumor size less than 5cm, no tumor thrombus and radical resection of HCC are premise of long-term survival of patients with HCC after hepatectomy.