Risk factors of poor prognosis and portal vein tumor thrombosis after curative resection of solitary hepatocellular carcinoma
Risk factors of poor prognosis and portal vein tumor thrombosis after curative resection of solitary hepatocellular carcinoma
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DOI：
10.1016/s1499-3872(13)60008-9
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发表时间：
2013-02-15
影响因子：
3.3
通讯作者：
Qu, Qiang
中科院分区：
文献类型：
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作者：
Zhou, Li;Rui, Jing-An;Qu, Qiang
背景：孤立性肝细胞癌(SHCC)是包括大多数恶性肿瘤患者的一个亚型，其预后不良的预测因素仍然存在争议。因此，小肝癌门静脉癌栓(PVTT)的危险因素尚不清楚。方法：对156例小肝癌根治性肝切除患者的临床病理和随访资料进行单因素和多因素分析。结果：单因素分析显示PVTT、肿瘤转移(TNM)分期、Edmondson-Steiner分级和术前血清甲胎蛋白(AFP)水平与总无瘤生存期相关，而肿瘤大小仅影响总生存期。在多变量Cox回归检验中，Edmondson-Steiner分级和TNM分期是影响总生存率和无瘤生存率的独立预后指标。卡方检验显示AFP水平和Edmondson-Steiner分级与PVTT相关。在多因素Logistic回归分析中，仅Edmondson-Steiner分级对PVTT有独立意义。结论：与小肝癌术后预后和门静脉血栓形成有关的因素均与肿瘤有关。其中，Edmondson-Steiner分级和TNM分期在生存分析中可能特别重要。此外，根据临床病理参数在手术前准确预测PVTT仍然是困难的。(肝胆胰脏疾病2013；12：68-73)
BACKGROUND: Predictors of poor prognosis of solitary hepatocellular carcinoma (SHCC), a subgroup encompassing most patients with the malignancy, are still controversial. Hence, risk factors for portal vein tumor thrombosis (PVTT) in SHCC are obscure. The present study was designed to address this issue.METHOD: Clinicopathological and follow-up data for 156 consecutive patients with SHCC following curative hepatic resection were analyzed using uni- and multi-variate analyses.RESULTS: Univariate analysis showed that PVTT, tumor-node-metastasis (TNM) stage, Edmondson-Steiner grade and preoperative serum alpha-fetoprotein (AFP) level were associated with the overall and disease-free survival, whereas tumor size only influenced the overall survival. In multivariate Cox regression tests, Edmondson-Steiner grade and TNM stage were independent prognostic markers for both overall and disease-free survival. In addition, the Chi-square test showed that AFP level and Edmondson-Steiner grade were correlated with PVTT. Among them, only Edmondson-Steiner grade was shown to be of independent significance for PVTT in multi-variate logistic regression analysis. Additionally, AFP, the sole preoperative factor for PVTT, was not adequately sensitive and specific.CONCLUSIONS: Factors relating to post-surgical prognosis and PVTT in SHCC are all tumor-related. Of these, Edmondson-Steiner grade and TNM stage might be of particular importance in survival analysis. In addition, accurate prediction of PVTT by clinicopathological parameters before surgery remains difficult. (Hepatobiliary Pancreat Dis Int 2013;12:68-73)