老年可切除肝癌伴门静脉癌栓预后的影响因素分析
|
摘要
目的:探讨老年可切除肝癌伴门静脉癌栓预后的影响因素。方法:选择我院于2014年1月至2017年6月期间收治的老年可切除肝癌伴门静脉癌栓患者127例作为研究对象,均行肝癌根治性切除+门静脉切开取栓、门静脉癌切除、右半肝或者左半肝切除。所有患者出院后开始随访,以每6个月电话或者门诊随访其生存情况,至其死亡或随访至2018年8月。调查资料包括性别、分化程度、肿瘤直径、癌栓分型、合并肝硬化、甲胎蛋白、术后TACE、肝内转移、癌栓类型。结果:随访末,生存患者42例,死亡患者85例。两组患者在性别、分化程度、癌栓类型和甲胎蛋白方面比较无统计学差异(P>0.05);死亡组低分化多于生存组,肿瘤直径≥8 cm多于生存组,合并肝硬化多于生存组,术后TACE多于生存组,有肝内转移多于生存组,浸润癌栓类型多于生存组,且有统计学差异(P<0.05)。将上述单因素分析具有统计学差异的纳入多因素分析表明,低分化、肿瘤直径≥8cm、术后TACE、肝内转移和浸润型癌栓为影响肝癌伴门静脉癌栓预后独立危险因素。结论:老年可切除肝癌伴门静脉癌栓预后受多种因素影响,其中分化程度、肿瘤直径、术后TACE、肝内转移和癌栓类型为影响其预后独立危险因素。
Objective:To investigate the prognostic factors of elderly resectable hepatocellular carcinoma(HCC)with portal vein tumor thrombus. Methods: From January 2014 to June 2017,127 elderly patients with resectable hepatocellular carcinoma and portal vein tumor thrombus were selected as subjects. All patients underwent radical hepatectomy plus portal vein thrombectomy,portal vein cancer resection,right or left hepatectomy. All patients were followed up every six months by telephone or out-patient for survival until their deaths or until August 2018. The data included sex,differentiation,tumor diameter,tumor thrombus type,cirrhosis,AFP,postoperative TACE,intrahepatic metastasis,and tumor thrombus type.Results:At the end of the follow-up,42 patients survived and 85 died.There was no significant difference in sex,differentiation,tumor thrombus type and alpha fetoprotein between the two groups(P>0.05); low differentiation was more common in the death group than in the survival group,tumor diameter was more than 8 cm in the survival group,cirrhosis was more common in the survival group,postoperative TACE was more common in the survival group,intrahepatic metastasis was more common in the survival group,and infiltrating tumor thrombus was more common in the survival group(P<0.05).Multivariate analysis showed that low differentiation,tumor diameter≥8 cm,postoperative TACE,intrahepatic metastasis and invasive tumor thrombus were independent risk factors for prognosis of HCC with portal vein tumor thrombus.Conclusion:The prognosis of resectable hepatocellular carcinoma with portal vein tumor thrombus in elderly patients is influenced by many factors,among which differentiation,direct tumor,postoperative TACE,intrahepatic metastasis and type of tumor thrombus are independent risk factors.
Objective:To investigate the prognostic factors of elderly resectable hepatocellular carcinoma(HCC)with portal vein tumor thrombus. Methods: From January 2014 to June 2017,127 elderly patients with resectable hepatocellular carcinoma and portal vein tumor thrombus were selected as subjects. All patients underwent radical hepatectomy plus portal vein thrombectomy,portal vein cancer resection,right or left hepatectomy. All patients were followed up every six months by telephone or out-patient for survival until their deaths or until August 2018. The data included sex,differentiation,tumor diameter,tumor thrombus type,cirrhosis,AFP,postoperative TACE,intrahepatic metastasis,and tumor thrombus type.Results:At the end of the follow-up,42 patients survived and 85 died.There was no significant difference in sex,differentiation,tumor thrombus type and alpha fetoprotein between the two groups(P>0.05); low differentiation was more common in the death group than in the survival group,tumor diameter was more than 8 cm in the survival group,cirrhosis was more common in the survival group,postoperative TACE was more common in the survival group,intrahepatic metastasis was more common in the survival group,and infiltrating tumor thrombus was more common in the survival group(P<0.05).Multivariate analysis showed that low differentiation,tumor diameter≥8 cm,postoperative TACE,intrahepatic metastasis and invasive tumor thrombus were independent risk factors for prognosis of HCC with portal vein tumor thrombus.Conclusion:The prognosis of resectable hepatocellular carcinoma with portal vein tumor thrombus in elderly patients is influenced by many factors,among which differentiation,direct tumor,postoperative TACE,intrahepatic metastasis and type of tumor thrombus are independent risk factors.
引文
[1] Cheng S,Yang J,Shen F,et al.Multidisciplinary management of hepatocellular carcinoma with portal vein tumor thrombus-Eastern Hepatobiliary Surgical Hospital consensus statement[J].Oncotarget,2016,7(26):40816-40829.
[2] Zhang YF,Le Y,Wei W,et al.Optimal surgical strategy for hepatocellular carcinoma with portal vein tumor thrombus:a propensity score analysis[J].Oncotarget,2016,7(25):38845-38856.
[3] 邢志祥,沈世强,秦峰,等.肝癌切除术后辅助性经肝动脉化疗栓塞术对患者生存的影响及预后相关因素分析[J].临床肝胆病杂志,2017,3(12):2331-2336.
[4] Sun JX,Shi J,Li N,et al.Portal vein tumor thrombus is a bottleneck in the treatment of hepatocellular carcinoma[J].Cancer Biology & Medicine,2016,13(4):452-458.
[5] 冯浩,龚伟,夏晓华,等.复杂性肝癌的手术切除治疗效果及影响因素分析[J].海南医学,2017,28(23):3936-3938.
[6] 陈晋,王晓龙,朱日祥.影响肝癌合并门脉高压症患者行R0切除的疗效、安全性及预后的因素分析[J].临床外科杂志,2017,25(3):182-185.
[7] Ye JZ,Wang YY,Bai T,et al.Surgical resection for hepatocellular carcinoma with portal vein tumor thrombus in the Asia-Pacific region beyond the Barcelona Clinic Liver Cancer treatment algorithms:a review and update[J].Oncotarget,2017,8(54):93258-93278.
[8] 刘海婷,戴建立,刘燕芳,等.糖尿病对手术切除术后原发性肝癌患者预后影响的Meta分析[J].中国慢性病预防与控制,2017,25(10):790-793.
[9] 张艳君,徐阳,韩亚茹.肝功能化疗栓塞术联合125I粒子及支架植入治疗肝癌伴门静脉癌栓的护理研究[J].山西医药杂志,2017,46(5):597-600.
[10] 刘辉,张曦,肖森林,等.肝硬化肝癌患者手术切除预后影响因素的回顾性研究[J].第三军医大学学报,2017,39(20):2022-2029.
[11] 郝君锋,祁亚斌,高校奇,等.肝癌患者术前不同脾肝体积比对肝部分切除术预后的预测对比[J].中国医师杂志,2017,19(1):92-95.
[12] 刘嘉烨,李川,天夫,等.肝细胞肝癌伴脉管癌栓单纯手术切除与切除术后联合介入治疗预后对比[J].局解手术学杂志,2016,25(5):331-335.
[13] 崔云龙,李强,张倜,等.肝细胞癌合并门静脉癌栓患者手术治疗预后影响因素[J].中华肝脏外科手术学电子杂志,2016,5(4):249-253.
[14] 高胜,刘剑勇,张志明,等.肝细胞癌伴门脉癌栓两种手术方式的疗效及预后因素[J].中华肝胆外科杂志,2014,20(10):700-704.
[15] 王毅,杨振华,柏尚柱,等.手术切除与介入治疗巴塞罗那C期肝癌伴门静脉癌栓患者预后比较[J].局解手术学杂志,2017,26(7):509-513.
[16] 黄书明,陈圣开,张涛.肝癌切除术联合术后TACE对肝癌合并门静脉癌栓患者的治疗效果及预后影响因素分析[J].中国医学前沿杂志:电子版,2016,8(6):160-164.
[2] Zhang YF,Le Y,Wei W,et al.Optimal surgical strategy for hepatocellular carcinoma with portal vein tumor thrombus:a propensity score analysis[J].Oncotarget,2016,7(25):38845-38856.
[3] 邢志祥,沈世强,秦峰,等.肝癌切除术后辅助性经肝动脉化疗栓塞术对患者生存的影响及预后相关因素分析[J].临床肝胆病杂志,2017,3(12):2331-2336.
[4] Sun JX,Shi J,Li N,et al.Portal vein tumor thrombus is a bottleneck in the treatment of hepatocellular carcinoma[J].Cancer Biology & Medicine,2016,13(4):452-458.
[5] 冯浩,龚伟,夏晓华,等.复杂性肝癌的手术切除治疗效果及影响因素分析[J].海南医学,2017,28(23):3936-3938.
[6] 陈晋,王晓龙,朱日祥.影响肝癌合并门脉高压症患者行R0切除的疗效、安全性及预后的因素分析[J].临床外科杂志,2017,25(3):182-185.
[7] Ye JZ,Wang YY,Bai T,et al.Surgical resection for hepatocellular carcinoma with portal vein tumor thrombus in the Asia-Pacific region beyond the Barcelona Clinic Liver Cancer treatment algorithms:a review and update[J].Oncotarget,2017,8(54):93258-93278.
[8] 刘海婷,戴建立,刘燕芳,等.糖尿病对手术切除术后原发性肝癌患者预后影响的Meta分析[J].中国慢性病预防与控制,2017,25(10):790-793.
[9] 张艳君,徐阳,韩亚茹.肝功能化疗栓塞术联合125I粒子及支架植入治疗肝癌伴门静脉癌栓的护理研究[J].山西医药杂志,2017,46(5):597-600.
[10] 刘辉,张曦,肖森林,等.肝硬化肝癌患者手术切除预后影响因素的回顾性研究[J].第三军医大学学报,2017,39(20):2022-2029.
[11] 郝君锋,祁亚斌,高校奇,等.肝癌患者术前不同脾肝体积比对肝部分切除术预后的预测对比[J].中国医师杂志,2017,19(1):92-95.
[12] 刘嘉烨,李川,天夫,等.肝细胞肝癌伴脉管癌栓单纯手术切除与切除术后联合介入治疗预后对比[J].局解手术学杂志,2016,25(5):331-335.
[13] 崔云龙,李强,张倜,等.肝细胞癌合并门静脉癌栓患者手术治疗预后影响因素[J].中华肝脏外科手术学电子杂志,2016,5(4):249-253.
[14] 高胜,刘剑勇,张志明,等.肝细胞癌伴门脉癌栓两种手术方式的疗效及预后因素[J].中华肝胆外科杂志,2014,20(10):700-704.
[15] 王毅,杨振华,柏尚柱,等.手术切除与介入治疗巴塞罗那C期肝癌伴门静脉癌栓患者预后比较[J].局解手术学杂志,2017,26(7):509-513.
[16] 黄书明,陈圣开,张涛.肝癌切除术联合术后TACE对肝癌合并门静脉癌栓患者的治疗效果及预后影响因素分析[J].中国医学前沿杂志:电子版,2016,8(6):160-164.