巨大肝癌外科治疗的预后影响因素-论文.pdf

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1、·328·2014年5月第2O卷第5期ChinJHepatobiliarySurg，May2014，Vo1．20,No．5·论著·巨大肝癌外科治疗的预后影响因素吴凡王黎明吴健雄刘立国荣维淇余微波安松林刘发强冯莉田斐【摘要】目的分析外科治疗巨大肝癌的预后相关因素，提高其综合治疗水平。方法回顾性分析51例经外科治疗的巨大肝癌患者的临床资料。应用Kapla—Meier方法计算生存时间，Cox回归法对15个可能与预后相关的临床病理因素进行统计学分析。结果50例患者获得随访。术后1、3、5年生存率分别为75．8％、37．9％和21．1％。单因素分析显示术前AFP大于400

2、L、肿瘤大于12em、肿瘤边界是否清楚、有无血管侵犯、TNM分期与巨大肝癌的预后有关；Cox多因素回归分析结果显示，有无血管侵犯、肿瘤边界是否清楚、肿瘤大于12cm是影响巨大肝癌预后的独立因素。单因素分析显示肿瘤边界是否清楚、有无血管侵犯、TNM分期是影响患者复发的重要因素；Cox多因素分析显示血管侵犯是影响患者复发的独立因素。结论外科治疗巨大肝癌相对安全可靠，可改善患者预后。对高危因素患者需要依靠综合治疗以延长生存期。【关键词】肝癌；肝切除术；预后Prognosticfactorsforpatientswhounderwentsurgicaltreatment

3、forhugelivercancerWuFan，WangLiming，WuJianxiong，LiuLiguo，RongWeiqi，YuWeibo，AnSonglin，LiuFaqiang，Li，TianFei．DepartmentofHepatobiliarySurgery，CancerHospital，ChineseAcademyofMedicalSciencesandPekingUnionMedicalCollege，Beijing100021，ChinaCorrespondingauthor：WuJianxiong，EmaiZ：dr．@hotmail．c

4、om【Abstract】ObjectiveToanalyzetheprognosticfactorsforpatientswhounderwentsurgicalresec—tionforhugelivercancerSOastoimprovethemedicalresultsofcomprehensivetherapy．MethodsWeret—rospectivelyanlaysedthedataof51patientswhounderwentsurgicalresectionforhugelivercancer．Fifteenclinicopatholog

5、icfactorspossiblyinfluencingsurvivalwereselected，andmultivariateanalysisoftheseparam—eterswasperformedusingtheCoxproportionalhazardsmode1．SurvivalanalysiswasdoneusingtheKaplan—Meiermethod．ResultsTheoverall1一，3一，5-yearsurvivalratesof50patientswere75．8％，37．9％and21．1％，respectively．Univa

6、riateanalysisshowedthatAFPover400g／L，tumordiameterover12cm，tumorboundary，vascularinvasionandTNMstagingsignificantlyaffectedpostoperativesurviva1．Coxmuhi—variateanalysisindicatedthattumordiameterof≥12cm．tumorboundaryandvascularinvasionwereinde·pendentprognosticfactors．Univariateanalys

7、isshowedthattumorboundary，vascularinvasionandTNMstagingweretheindependentfactorsafectingrecurrence，Coxmultivariateanalysisshowedthatvascularin—vasionwasanindependentfactorinfluencingrecurenceoftumor．ConclusionsSurgicalresectionforpa—tientswithhugelivercancercouldbesafelyperformedwith

8、reasonablelo