探讨肿瘤直径与肝细胞癌（肝癌）肝切除患者预后的关系。

回顾性分析2002年12月至2011年12月在西安交通大学第一附属医院行根治性肝切除并经病理学检查证实为肝癌的172例患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定。其中男139例，女33例；年龄≤55岁98例，>55岁74例。绘制患者术后生存时间和肿瘤直径关系的受试者工作特征（ROC）曲线，确定肿瘤直径界值为5.75 cm。根据最佳界值将患者分为小肝癌组（肿瘤直径< 5.75 cm，85例）和大肝癌组（肿瘤直径≥5.75 cm，87例）。分析肿瘤直径与临床病理学参数关系。比较两组患者中位生存期、累积生存率、无瘤生存率。将临床病理学参数纳入影响患者生存预后的因素进行独立危险因素分析。肿瘤直径与临床病理学参数关系采用χ²检验，生存预后分析采用Kaplan-Meier法和Log-rank检验。单因素和多因素分析采用Cox比例风险模型。

肿瘤直径与患者术前AFP、肿瘤数目、TNM分期有关（χ²=13.272，9.378，7.311；P<0.05）。大肝癌组的中位生存期为24个月，中位复发时间9个月；小肝癌组相应为39、37个月。大肝癌组的1、3、5年累积生存率分别为65.5%、36.0%、22.9%，小肝癌组相应为89.5%、76.3%、72.5%，大肝癌组的总体生存率明显低于小肝癌组（χ²=33.644，P<0.05）。大肝癌组的1、3、5年无瘤生存率分别为44.7%、25.5%、21.9%，小肝癌组相应为84.8%、67.8%、66.3%，大肝癌组的无瘤生存率明显低于小肝癌组（χ²=38.908，P<0.05）。术前Plt≥155×10⁹/L、肿瘤直径>5.75 cm和TNM分期晚期是影响肝癌患者术后预后的独立危险因素（HR=1.588，3.066，2.029；P<0.05）。

肿瘤直径是影响肝癌肝切除术患者预后的独立危险因素，肿瘤直径>5.75 cm患者预后差。

To investigate the association between tumor size and prognosis of patients with hepatocellular carcinoma (HCC) after hepatectomy.

Clinical data of 172 patients undergoing radical hepatectomy and diagnosed as HCC by pathological examination in the First Affiliated Hospital of Xi'an Jiaotong University between December 2002 and December 2011 were retrospectively studied. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 172 patients, 139 were males and 33 were females; 98 were with age ≤55 years old and 74 were with age >55 years old. The receiver operating characteristic (ROC) curve of the relationship between postoperative survival time and tumor size was drawn, and the cut-off value for tumor size was determined at 5.75 cm. According to the best cut-off value, the patients were divided into the small HCC group (tumor size < 5.75 cm, n=85) and huge HCC group (tumor size≥5.75 cm, n=87). The relationship between tumor size and clinicopathologic parameters was analyzed, and the median survival time, cumulative survival rate and disease free survival rate of two groups were compared. The clinicopathologic parameters were included as the factors influencing the survival and prognosis of patients, and independent risk factor analysis was performed. The relationship between tumor size and clinicopathologic parameters was analyzed using Chi-square test. Kaplan-Meier method and Log-rank test were used for survival and prognosis analysis. Cox proportional hazard model was used for univariate analysis and multivariate analysis.

Tumor size was associated with the preoperative AFP, number of tumors and TNM staging (χ²=13.272, 9.378, 7.311; P<0.05). The median survival time and the median recurrence time for the huge HCC group were 24 months and 9 months respectively and were 39 months and 37 months for the small HCC group. The 1-, 3-, 5-year cumulative survival rate for the huge HCC group were 65.5%, 36.0%, 22.9% respectively and were 89.5%, 76.3%, 72.5% respectively for the small HCC group. The overall survival of the huge HCC group was lower than that of small HCC group (χ²=33.644, P<0.05). The 1-, 3-, 5-year disease free survival rate for the huge HCC group were 44.7%, 25.5%, 21.9% respectively and were 84.8%, 67.8%, 66.3% respectively for the small HCC group. The disease free survival rate of huge HCC group was lower than that of small HCC group (χ²=38.908, P<0.05). Preoperative platelets count (Plt)≥155×10⁹/L, tumor size > 5.75 cm and advanced stage of TNM were the independent risk factors influencing the postoperative prognosis of HCC patients (HR=1.588, 3.066, 2.029; P<0.05).

Tumor size is the independent risk factor influencing the prognosis of HCC patients after hepatectomy. The prognosis of patients with tumor size > 5.75 cm is poor.