微血管侵犯与孤立性大肝癌病理特征及根治术后疗效的关系研究

目的探讨微血管侵犯（MVI）与孤立性大肝癌的病理特征及其与根治术后疗效的相关性。方法回顾性分析2011年1 月-2014 年12月在该院普外科住院治疗的159例孤立性大肝癌的病理资料，根据患者有无发生MVI 将其分为无MVI 组（n =97）和有MVI 组（ n=62），分析两组患者的肿瘤大小、肿瘤分化、卫星结节与术后无进展期的关系。结果孤立性大肝癌根治术后的1、3 和5 年生存率分别为882％、56.7％和41.4％。单因素分析显示，年龄、性别、MVI、甲胎蛋白（AFP）、肿瘤分化程度、肿瘤直径和数量、卫星结节与孤立性大肝癌术后无进展期有关；多因素分析显示，AFP>400 ng/ml、MVI、卫星结节、肿瘤数量及肿瘤直径是孤立性大肝癌术后无进展期的危险因素。MVI 发生率为43.7％。其中无MVI 患者的中位无进展生存期为47 个月，1、3 和5 年无进展生存率分别为91.7％、67.5％和56.0％；有MVI 患者的中位无进展生存期为35 个月，1 和3 年无进展生存率分别为84.7％和45.8％。结论AFP>400 ng/ml、MVI、卫星结节、肿瘤数量及肿瘤直径是影响孤立性大肝癌根治术后无进展生存期的重要因素。

Relationship between microvascular invasion and pathological features of solitary large hepatocellular carcinoma and curative effect after radical

To investigate the relationship between microvessel invasion (MVI) and solitary large hepatocellular carcinoma (HCC) and its correlation with curative effect after radical operation. Methods 159 cases of isolated large hepatocellular carcinoma were retrospectively analyzed. The patients were divided into MVI group (n = 97) and MVI group ( n= 62) according to the presence or absence of MVI. Further analysis and comparison of two groups of patientsincluding tumor size, tumor differentiation, MVI, satellite nodules and postoperative non-progression (p < 0.05). And the relationship between MVI and the above pathological indexes were analyzed. Results The 1, 3 and 5 year survival rates of solitary large hepatocarcinoma were 88.2%,56.7% and 41.4%, respectively. Univariate analysis showed that MVI, low tumor differentiation and tumor di-ameter > 4 cm were the risk factors for the progression of solitary hepatocellular carcinoma without progression.Univariate analysis showed that MVI was a non-progression independent risk factors. The incidence of MVI was 43.7%. The median progression-free survival was 47 months in patients without MVI, and 91.7%, 67.5%,56.0% in 1, 3 and 5 years. The median progression-free survival in MVI patients was 35 month, 1 and 3-year progression-free survival rates were 84.7% and 45.8%. Univariate analysis showed that the low degree of tumor differentiation is a risk factor for MVI. Multivariate analysis showed that low tumor differentiation was an independent risk factor for MVI. Conclusions AFP > 400 ng/ml, MVI, satellite nodules, tumor volume andtumor diameter are important factors that affect the progression-free survival of solitary large hepatocellular carcinoma after radical operation. Among them, MVI is the most significant factor.