Factors affecting the recurrence and survival of hepatocellular carcinoma after hepatectomy: a retrospective study of 601 Chinese patients
Factors affecting the recurrence and survival of hepatocellular carcinoma after hepatectomy: a retrospective study of 601 Chinese patients
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DOI：
10.1007/s12094-015-1446-0
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发表时间：
2016-08-01
影响因子：
3.4
通讯作者：
Bai, L.
中科院分区：
文献类型：
--
作者：
Zhang, T. T.;Zhao, X. Q.;Bai, L.
肝细胞癌（HCC）的切除指征仍存在争议。本研究旨在探讨影响肝癌切除术后总生存期（OS）和无病生存期（DFS）的预后因素。分析了宿主、生化、手术治疗和肿瘤相关特征对复发和总生存率的影响。采用Kaplan-Meier生存分析和考克斯比例风险模型对影响预后的因素进行单因素和多因素分析，1、3和5年总生存率分别为79、62和54%，相应的DFS率分别为51、38和31%。在多变量分析中，Child-Pugh、血清AFP水平、ALT水平、肝切除时间、肿瘤分化程度、肿瘤最大尺寸、局部坏死、门静脉癌栓和TNM分期与患者的OS显著相关。（P = 0.046），吸烟（P = 0.007），血清AFP水平（P = 0.001），GGT水平（P = 0.002），肿瘤的最大尺寸（P = 0.009），肝硬化（P = 0.025），门静脉癌栓（P = 0.022），微血管癌栓（P = 0.007）和TNM分期（P = 0.001）术前AFP水平、肿瘤最大体积、门静脉癌栓和TNM分期是影响OS和DFS的重要预后因素。
Indications for resection of hepatocellular carcinoma (HCC) remain controversial. This study aimed to identify prognostic factors that affect overall survival (OS) and disease-free survival (DFS) in patients with HCC after hepatectomy.From 2004 to 2010, 601 patients with HCC who underwent resection were enrolled. Factors stratified into the host, biochemical, surgical treatment and tumor-related features in terms of recurrence and overall survival were analyzed. Prognostic factors were evaluated by univariate and multivariate analyses, with Kaplan-Meier survival analyses and Cox proportional hazard model.The overall survival rates of 1-, 3- and 5- year were 79, 62, and 54 %, and the corresponding DFS rates were 51, 38 and 31 %, respectively. In a multivariate analysis, Child-Pugh, serum AFP level, ALT level, time for hepatic resection, tumor differentiation, maximum size of tumors, local necrosis, portal vein tumor thrombus, and TNM Stage were correlated significantly with patients' OS. Gender (P = 0.046), cigarette smoking (P = 0.007), serum AFP level (P = 0.001), GGT level (P = 0.002), maximum size of tumors (P = 0.009), liver cirrhosis (P = 0.025), portal vein tumor thrombus (P = 0.022), microvascular tumor thrombus (P = 0.007) and TNM Stage (P = 0.001) were significantly affected DFS.Preoperative AFP level, maximum size of tumors, portal vein tumor thrombus and TNM Stage were revealed as important prognostic factors for OS and DFS through follow-up of a relatively large cohort of Chinese HCC patients.