宽切缘根治切除治疗伴微血管侵犯的原发性肝癌患者预后及原发性肝癌手术患者短期预后影响因素分析
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摘要
目的分析宽切缘根治切除治疗伴微血管侵犯(microvascular invation, MVI)的原发性肝癌患者预后及原发性肝癌手术患者短期预后的影响因素。方法选取2012年1月—2015年12月我院收治的345例原发性肝癌患者作为研究对象,对其临床及随访资料进行回顾性分析,比较MVI阳性组和MVI阴性组采用宽切缘与窄切缘手术治疗后3年的复发率及生存率;比较宽切缘组(切缘≥1 cm)和窄切缘组(切缘<1 cm)患者术后并发症发生情况;分析影响原发性肝癌手术患者短期预后的因素。结果 MVI阳性组采用宽切缘手术切除患者较窄切缘手术切除患者,术后3年复发率明显降低,3年生存率明显升高,差异均有统计学意义(P<0.01);MVI阴性组不同手术切缘患者术后3年复发率及生存率比较差异均无统计学意义(P>0.05)。宽切缘组和窄切缘组术后总并发症发生率比较差异无统计学意义(P>0.05)。非条件多因素logistic回归分析显示,窄切缘、肿瘤直径>5 cm、MVI阳性、肿瘤包膜不完整及血清甲胎蛋白水平过高为原发性肝癌手术患者短期预后的独立危险因素。结论宽切缘根治切除治疗伴MVI的原发性肝癌患者预后较好,且具有一定的安全性;窄切缘、肿瘤直径>5 cm、MVI阳性、肿瘤包膜不完整及血清甲胎蛋白水平过高为原发性肝癌手术患者短期预后的独立危险因素。
Objective To analyze the prognosis and influencing factors of short-term prognosis in patients with primary liver cancer and microvascular invasion(MVI) treated by resection with wide margin. Methods A total of 345 patients with primary liver cancer admitted to our hospital from January 2012 to December 2015 were selected as subjects. The clinical and follow-up data were retrospectively analyzed. Moreover, 3-year survival and recurrence rate in MVI positive group and MVI negative group were compared between patients with liver cancer who underwent resection with wide margin and those with narrow margin. The postoperative complications of patients in wide margin group(cut margin ≥1 cm) and narrow margin group(cut margin <1 cm) were analyzed. The factors affecting the short-term prognosis of patients with primary liver cancer were analyzed. Results For MVI positive patients with liver cancer, compared with patients with wide margin, those with narrow margin had a significantly lower 3-year recurrence rate and a significantly higher 3-year survival rate(P<0.05). For MVI negative patients with liver cancer, there was no difference in 3-year recurrence rate and survival rate(P>0.05).There was no significant difference in the incidence of complications between the wide margin and the narrow margin groups(P>0.05). Non-conditional multivariate logistic regression model showed that resection with narrow margins, diameter of tumor>5 cm, MVI positive, incompleteness of tumor capsule and excessively high levels of serum alpha-fetoprotein were independent risk factors affecting the short-term prognosis of patients with primary liver cancer. Conclusion Resection with wide margin for the treatment of MVI patients with primary liver cancer has a better prognosis and a certain degree of safety. Narrow margin, diameter of tumor >5 cm, MVI positive, incompleteness of tumor capsule and high levels of serum alpha-fetoprotein are independent risk factors for short-term prognosis in patients with primary liver cancer.
Objective To analyze the prognosis and influencing factors of short-term prognosis in patients with primary liver cancer and microvascular invasion(MVI) treated by resection with wide margin. Methods A total of 345 patients with primary liver cancer admitted to our hospital from January 2012 to December 2015 were selected as subjects. The clinical and follow-up data were retrospectively analyzed. Moreover, 3-year survival and recurrence rate in MVI positive group and MVI negative group were compared between patients with liver cancer who underwent resection with wide margin and those with narrow margin. The postoperative complications of patients in wide margin group(cut margin ≥1 cm) and narrow margin group(cut margin <1 cm) were analyzed. The factors affecting the short-term prognosis of patients with primary liver cancer were analyzed. Results For MVI positive patients with liver cancer, compared with patients with wide margin, those with narrow margin had a significantly lower 3-year recurrence rate and a significantly higher 3-year survival rate(P<0.05). For MVI negative patients with liver cancer, there was no difference in 3-year recurrence rate and survival rate(P>0.05).There was no significant difference in the incidence of complications between the wide margin and the narrow margin groups(P>0.05). Non-conditional multivariate logistic regression model showed that resection with narrow margins, diameter of tumor>5 cm, MVI positive, incompleteness of tumor capsule and excessively high levels of serum alpha-fetoprotein were independent risk factors affecting the short-term prognosis of patients with primary liver cancer. Conclusion Resection with wide margin for the treatment of MVI patients with primary liver cancer has a better prognosis and a certain degree of safety. Narrow margin, diameter of tumor >5 cm, MVI positive, incompleteness of tumor capsule and high levels of serum alpha-fetoprotein are independent risk factors for short-term prognosis in patients with primary liver cancer.
引文
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[11] 宋祥勇,张军,张永川.腹腔镜肝切除术与开腹肝切除术治疗原发性大肝癌近期疗效及远期预后对比分析[J].解放军预防医学杂志,2018,36(4):451-454.
[12] 张小晶,刘静,刘坤,等.微血管侵犯对肝癌肝切除术后预后的影响[J].中华消化外科杂志,2018,17(5):483-487.
[13] 张大为,何津,张海光,等.复方苦参注射液配合术中切缘处理对原发性肝癌患者术后复发转移的影响研究[J].现代中西医结合杂志,2017,26(21):2348-2350.
[14] 曹国良,蔡庆,李幼安,等.肝细胞癌微血管侵犯的危险因素分析及预后[J].中华消化外科杂志,2017,16(10):1048-1052.
[15] 孙志德,程利民,平萍,等.影响原发性肝癌患者手术治疗预后的危险因素分析[J].临床和实验医学杂志,2017,16(12):1204-1207.
[2] 刘驰,杨启,秦长岭.微血管侵犯对早期肝癌肝切除术切缘选择及患者预后的影响[J].肝胆外科杂志,2017,25(5):353-357.
[3] 程张军,周家华,沈锋.影响肝癌肝切除术后远期预后的手术相关因素[J].腹部外科,2018,31(2):73-76,81.
[4] 张努,荚卫东,王润东,等.解剖性肝切除对肝细胞癌伴微血管侵犯病人预后的影响[J].中国实用外科杂志,2018,38(5):555-559.
[5] 马思聪,王涛,丁敏,等.超声引导下微波消融一线治疗原发性肝癌:临床疗效以及预后影响因素[J].肝脏,2016,21(5):355-359.
[6] 王华利,熊清芳,杨永峰.279例老年原发性肝癌临床特点及预后影响因素分析[J].实用老年医学,2017,31(12):1135-1137.
[7] 陈矗,倪怀坤.原发性肝癌骨转移患者预后相关影响因素分析[J].武警医学,2016,27(11):1106-1109.
[8] 廖晓兰.2015-2016年成宁市居民恶性肿瘤死亡分析[J].预防医学情报杂志,2018,34(7):911-914.
[9] 杨创勃,王军,段海峰,等.宝石能谱CT定量评估小肝癌微血管侵犯的临床研究[J].实用放射学杂志,2016,32(6):879-883.
[10] 汪宇,李锡锋,张小峰,等.术前外周血循环肿瘤细胞检测对原发性肝细胞肝癌微血管侵犯的预测价值[J].山东医药,2017,57(18):33-35.
[11] 宋祥勇,张军,张永川.腹腔镜肝切除术与开腹肝切除术治疗原发性大肝癌近期疗效及远期预后对比分析[J].解放军预防医学杂志,2018,36(4):451-454.
[12] 张小晶,刘静,刘坤,等.微血管侵犯对肝癌肝切除术后预后的影响[J].中华消化外科杂志,2018,17(5):483-487.
[13] 张大为,何津,张海光,等.复方苦参注射液配合术中切缘处理对原发性肝癌患者术后复发转移的影响研究[J].现代中西医结合杂志,2017,26(21):2348-2350.
[14] 曹国良,蔡庆,李幼安,等.肝细胞癌微血管侵犯的危险因素分析及预后[J].中华消化外科杂志,2017,16(10):1048-1052.
[15] 孙志德,程利民,平萍,等.影响原发性肝癌患者手术治疗预后的危险因素分析[J].临床和实验医学杂志,2017,16(12):1204-1207.