原发性肝癌患者手术切除术后早期复发影响因素分析
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摘要
目的:探讨原发性肝癌(HCC)患者手术切除后早期复发的影响因素。方法:回顾性分析郑州大学第一附属医院2014年1月—2016年1月期间450例经手术切除的HCC患者的临床与随访资料,通过统计学方法分析HCC术后早期复发的影响因素。结果:450例患者中,2年内复发182例(40.4%)。单因素分析结果显示,HCC术后复发与门脉癌栓、术前血清AFP水平、肿瘤数目、最大直径、肿瘤分化程度有关(均P<0.05);Cox比例风险回归分析显示,肿瘤数目(RR=2.148,95%CI=1.175～3.924,P=0.013),肿瘤最大直径(RR=1.591,95%CI=1.006～2.518,P=0.047),门脉有无癌栓(RR=1.835,95%CI=1.242～2.709,P=0.001),血清AFP水平(RR=1.722,95%CI=1.141～2.601,P=0.010),肿瘤分化程度(RR=1.463,95%CI=1.071～1.998,P=0.017)均是HCC术后复发的独立因素。通过以上因素建立函数模型对预测HCC术后早期复发的风险程度有一定价值(似然比检验:χ~2=45.727,P<0.001)。结论:HCC患者手术切除术后早期复发的影响因素较多,其中门脉癌栓、肿瘤数目、最大直径、肿瘤分化程度、血清AFP水平可能是造成复发的独立危险因素,术前综合评估这些因素对预防术后复发有一定的指导意义。
Objective: To investigate the factors for early recurrence of patients with hepatocellular carcinoma(HCC) after surgical resection.Methods: The clinical and follow-up data of 450 HCC patients undergoing surgical resection from January 2014 to January 2016 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. The factors for early postoperative recurrence of HCC were determined by statistical analysis. Results: Of the 450 patients, recurrence within 2 years after surgery occurred in 182 cases(40.4%). Results of univariate analysis showed that portal vein tumor thrombus and preoperative serum AFP level as well as the number, maximum diameter and differentiation of the tumor were significantly associated with the postoperative recurrence of HCC(all P<0.05). Results of Cox proportional risk regression analysis showed that lesion number(RR=2.148, 95% CI=1.175–3.924, P=0.013), maximum diameter of tumor(RR=1.591, 95% CI=1.006–2.518, P=0.047), presence and absence of the portal vein tumor thrombus(RR=1.835, 95% CI=1.242–2.709, P=0.001), serum AFP level(RR=1.722, 95% CI=1.141–2.601, P=0.010), and degree of differentiation(RR=1.463, 95% CI=1.071–1.998, P=0.017) were all independent factors for postoperative recurrence of HCC. The functional prediction equation established by incorporating these factors had certain value in estimating the early postoperative recurrence of HCC(likelihood-ratio test: χ~2=45.727, P<0.001).Conclusion: There are multiple factors that affect the early recurrence of HCC patients after surgical resection, among which portal vein tumor thrombus, lesion number, and maximum diameter and differentiation degree of the tumor and serum AFP level may be independent risk factors for recurrence. Integrated evaluation of these factors before operation has certain directive significance in preventing postoperative recurrence.
Objective: To investigate the factors for early recurrence of patients with hepatocellular carcinoma(HCC) after surgical resection.Methods: The clinical and follow-up data of 450 HCC patients undergoing surgical resection from January 2014 to January 2016 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. The factors for early postoperative recurrence of HCC were determined by statistical analysis. Results: Of the 450 patients, recurrence within 2 years after surgery occurred in 182 cases(40.4%). Results of univariate analysis showed that portal vein tumor thrombus and preoperative serum AFP level as well as the number, maximum diameter and differentiation of the tumor were significantly associated with the postoperative recurrence of HCC(all P<0.05). Results of Cox proportional risk regression analysis showed that lesion number(RR=2.148, 95% CI=1.175–3.924, P=0.013), maximum diameter of tumor(RR=1.591, 95% CI=1.006–2.518, P=0.047), presence and absence of the portal vein tumor thrombus(RR=1.835, 95% CI=1.242–2.709, P=0.001), serum AFP level(RR=1.722, 95% CI=1.141–2.601, P=0.010), and degree of differentiation(RR=1.463, 95% CI=1.071–1.998, P=0.017) were all independent factors for postoperative recurrence of HCC. The functional prediction equation established by incorporating these factors had certain value in estimating the early postoperative recurrence of HCC(likelihood-ratio test: χ~2=45.727, P<0.001).Conclusion: There are multiple factors that affect the early recurrence of HCC patients after surgical resection, among which portal vein tumor thrombus, lesion number, and maximum diameter and differentiation degree of the tumor and serum AFP level may be independent risk factors for recurrence. Integrated evaluation of these factors before operation has certain directive significance in preventing postoperative recurrence.
引文
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[22]安建立,韩孝宇,沙俊峰,等.肝动脉化疗栓塞序贯微波消融治疗初治大肝癌1年内复发的影响因素分析[J].现代肿瘤医学,2018,26(18):2887-2892.doi:10.3969/j.issn.1672-4992.2018.18.016.An JL,Han XY,Sha JF,et al.Analysis of factors influencing 1year's recurrence of primary large hepatocellu-lar car-cinoma treated with transcatheter arterial chemoembolization and sequential micro-wave ablation[J].Journal of Modern Oncology,2018,26(18):2887-2892.doi:10.3969/j.issn.1672-4992.2018.18.016.
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[2]胡清雯,钱国军.冷循环微波消融结合TACE治疗肝癌的临床效果观察[J].中国普通外科杂志,2018,27(1):125-128.doi:10.3978/j.issn.1005-6947.2018.01.020.Hu QW,Qian GJ.Observation on clinical efficacy of cold circulation microwave ablation combined with TACE in treatment of hepatic cancer[J].Chinese Journal of General Surgery,2018,27(1):125-128.doi:10.3978/j.issn.1005-6947.2018.01.020.
[3]Liu MX,Jin L,Sun SJ,et al.Metabolic reprogramming by PCK1promotes TCA cataplerosis,oxidative stress and apoptosis in liver cancer cells and suppresses hepatocellular carcinoma[J].Oncogene,2018,37(12):1637-1653.doi:10.1038/s41388-017-0070-6.
[4]陈世发,赵礼金.肝癌发生发展机制的研究进展及其治疗现状[J].中国普通外科杂志,2018,27(7):910-923.doi:10.3978/j.issn.1005-6947.2018.07.016.Chen SF,Zhao LJ.Research progress on mechanisms for occurrence of liver cancer and its treatment status[J].Chinese Journal of General Surgery,2018,27(7):910-923.doi:10.3978/j.issn.1005-6947.2018.07.016.
[5]Capussotti L,Ferrero A,ViganòL,et al.Liver resection for HCC with cirrhosis:surgical perspectives out of EASL/AASLDguidelines[J].Eur J Surg Oncol,2009,35(1):11-15.doi:10.1016/j.ejso.2007.06.005.
[6]Heimbach JK,Kulik LM,Finn RS,et al.AASLD guidelines for the treatment of hepatocellular carcinoma[J].Hepatology,2018,67(1):358-380.doi:10.1002/hep.29086.
[7]张发鹏,袁荣发,张引,等.腹腔镜下射频消融治疗小肝癌的临床疗效分析[J].中国普通外科杂志,2018,27(1):35-41.doi:10.3978/j.issn.1005-6947.2018.01.006.Zhang FP,Yuan RF,Zhang Y,et al.Clinical efficacy of laparoscopic radiofrequency ablation in treatment of small primary hepatocellular carcinoma[J].Chinese Journal of General Surgery,2018,27(1):35-41.doi:10.3978/j.issn.1005-6947.2018.01.006.
[8]朱继领,张克瑞.射频消融与再手术治疗符合米兰标准的术后复发性肝癌的Meta分析[J].中国普通外科杂志,2017,26(7):838-846.doi:10.3978/j.issn.1005-6947.2017.07.005.Zhu JL,Zhang KR.Radiofrequency ablation versus surgical reresection for postoperative recurrent hepatocellular carcinoma within the Milan criteria:a Meta-analysis[J].Chinese Journal of General Surgery,2017,26(7):838-846.d o i:10.3978/j.issn.1005-6947.2017.07.005.
[9]Hayashi M,Shimizu T,Hirokawa F,et al.Clinicopathological risk factors for recurrence within one year after initial hepatectomy for hepatocellular carcinoma[J].Am Surg,2011,77(5):572-578.
[10]Lu X,Zhao H,Yang H,et al.A prospective clinical study on early recurrence of hepatocellular carcinoma after hepatectomy[J].J Surg Oncol,2009,100(6):488-493.doi:10.1002/jso.21354.
[11]Park JH,Koh KC,Choi MS,et al.Analysis of risk factors associated with early multinodular recurrences after hepatic resection for hepatocellular carcinoma[J].Am J Surg,2006,192(1):29-33.doi:10.1016/j.amjsurg.2005.11.010.
[12]Lai CL,Wu PC,Lam KC,et al.Histologic prognostic indicators in hepatocellular carcinoma[J].Cancer,1979,44(5):1677-1683.
[13]Chan AWH,Zhong J,Berhane S,et al.Development of pre and post-operative models to predict early recurrence of hepatocellular carcinoma after surgical resection[J].J Hepatol,2018,69(6):1284-1293.doi:10.1016/j.jhep.2018.08.027.
[14]Audisio RA,Bombelli L,Lombardi L,et al.A clinico-pathologic study of clear-cell hepatocellular carcinoma[J].Tumori,1987,73(4):389-395.
[15]Zhang X,Li J,Shen F,et al.Significance of presence of microvascular invasion in specimens obtained after surgical treatment of hepatocellular carcinoma[J].J Gastroenterol Hepatol,2018,33(2):347-354.doi:10.1111/jgh.13843.
[16]Lin DX,Zhang QY,Li X,et al.An aggressive approach leads to improved survival in hepatocellular carcinoma patients with portal vein tumor thrombus[J].J Cancer Res Clin Oncol,2011,137(1):139-149.doi:10.1007/s00432-010-0868-x.
[17]荚卫东,刘文斌.《肝细胞癌合并门静脉癌栓多学科诊治中国专家共识(2016年版)》解读[J].中国普通外科杂志,2017,26(7):815-820.doi:10.3978/j.issn.1005-6947.2017.07.001.Jia WD,Liu WB.Interpretation of Chinese Expert Consensus on Multidisciplinary Diagnosis and Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus(2016 edition)[J].Chinese Journal of General Surgery,2017,26(7):815-820.doi:10.3978/j.issn.1005-6947.2017.07.001.
[18]Chang IS,Shin SW,Cho SK,et al.Evolution of portal vein tumor thromboses in patients with hepatocellular carcinoma:CT findings and transition of serum tumor markers[J].Clin Imaging,2012,36(5):489-495.doi:10.1016/j.clinimag.2011.11.020.
[19]周松强,游燊,邱福南,等.肝癌切除术中Glisson蒂横断与第一肝门阻断的应用比较[J].中国普通外科杂志,2018,27(1):129-134.doi:10.3978/j.issn.1005-6947.2018.01.021.Zhou SQ,You B,Qiu FN,et al.Application of Glisson's pedicle transection compared with occlusion of the first porta hepatis during hepatic cancer resection[J].Chinese Journal of General Surgery,2018,27(1):129-134.doi:10.3978/j.issn.1005-6947.2018.01.021.
[20]汪超,黄建钊.肝细胞性肝癌术后复发的影响因素概况[J].中国民族民间医药,2016,25(11):31-33.Wang C,Huang JZ.Overview of factors for postoperative recurrence of hepatocellular carcinoma[J].Chinese Journal of Ethnomedicine and Ethnopharmacy,2016,25(11):31-33.
[21]张杰,段伯焕,朱功兵.肝细胞癌患者外科手术根治术后生存分析[J].实用肝脏病杂志,2017,20(1):93-96.doi:10.3969/j.issn.1672-5069.2017.01.024.Zhang J,Duan BH,Zhu GB.Affecting factors of survival of patients with hepatocellular carcinoma after radical surgical resection[J].Journal of Practical Hepatology,2017,20(1):93-96.doi:10.3969/j.issn.1672-5069.2017.01.024.
[22]安建立,韩孝宇,沙俊峰,等.肝动脉化疗栓塞序贯微波消融治疗初治大肝癌1年内复发的影响因素分析[J].现代肿瘤医学,2018,26(18):2887-2892.doi:10.3969/j.issn.1672-4992.2018.18.016.An JL,Han XY,Sha JF,et al.Analysis of factors influencing 1year's recurrence of primary large hepatocellu-lar car-cinoma treated with transcatheter arterial chemoembolization and sequential micro-wave ablation[J].Journal of Modern Oncology,2018,26(18):2887-2892.doi:10.3969/j.issn.1672-4992.2018.18.016.
[23]宋书红,郭俊,邹灿.肝癌手术切除术后复发相关因素分析[J].实用肝脏病杂志,2017,20(2):203-206.doi:10.3969/j.issn.1672-5069.2017.02.019.Song SH,Guo J,Zou C.Factors influencing postoperative recurrence in patients with primary liver cancer after hepatectomy[J].Journal of Practical Hepatology,2017,20(2):203-206.doi:10.3969/j.issn.1672-5069.2017.02.019.
[24]黄金球,彭民浩,邹全庆,等.原发性肝癌切除术后早期复发高危因素分析[J].中国实用外科杂志,2009,29(5):418-420.Huang JQ,Peng MH,Zou QQ,et al.Analysis of risk factors for early recurrence of primary hepatocellular carcinoma after radical hepatectomy[J].Chinese Journal of Practical Surgery,2009,29(5):418-420.
[25]Yuan Y,Yuan R,Chai Y,et al.A Reagentless Amperometric Immunosensor for Alpha Fetoprotein Based on Gold Nanoparticles/TiO2 Colloids/Prussian Blue Modified Platinum Electrode[J].Electroanalysis,2007,19(13):1402-1410.
[26]Gao Q,Han J,Ma Z.Polyamidoamine dendrimers-capped carbon dots/Au nanocrystal nanocomposites and its application for electrochemical immunosensor[J].Biosens Bioelectron,2013,49:323-328.doi:10.1016/j.bios.2013.05.048.
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