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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2016, Vol. 05 ›› Issue (04) : 249 -253. doi: 10.3877/cma.j.issn.2095-3232.2016.04.011

所属专题： 文献；

临床研究

肝细胞癌合并门静脉癌栓患者手术治疗预后影响因素
崔云龙1, 李强1, 张倜1, 孔大陆1, 李慧锴1, 武强1, 宋天强1,†()   
  1. 1. 300060　天津医科大学附属肿瘤医院肝胆肿瘤科　天津市肿瘤防治重点实验室
  • 收稿日期:2016-04-28 出版日期:2016-08-10
  • 通信作者: 宋天强

Influencing factors for prognosis of patients with hepatocellular carcinoma complicated with portal vein tumor thrombus after surgical treatment

Yunlong Cui1, Qiang Li1, Ti Zhang1, Dalu Kong1, Huikai Li1, Qiang Wu1, Tianqiang Song1,†()   

  1. 1. Department of Hepatobiliary Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjing 300060, China
  • Received:2016-04-28 Published:2016-08-10
  • Corresponding author: Tianqiang Song
  • About author:
    Corresponding author: Song Tianqiang, Email:
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引用本文：

崔云龙, 李强, 张倜, 孔大陆, 李慧锴, 武强, 宋天强. 肝细胞癌合并门静脉癌栓患者手术治疗预后影响因素[J]. 中华肝脏外科手术学电子杂志, 2016, 05(04): 249-253.

Yunlong Cui, Qiang Li, Ti Zhang, Dalu Kong, Huikai Li, Qiang Wu, Tianqiang Song. Influencing factors for prognosis of patients with hepatocellular carcinoma complicated with portal vein tumor thrombus after surgical treatment[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2016, 05(04): 249-253.

目的

探讨肝细胞癌（肝癌）合并门静脉癌栓患者手术治疗后的预后影响因素。

方法

回顾性分析2010年6月至2013年6月在天津医科大学附属肿瘤医院行手术治疗的32例肝癌合并门静脉癌栓患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定。其中男25例，女7例；年龄35～75岁，中位年龄66岁。观察患者1、2、3年累积生存率和无复发生存率，并分析影响患者总体生存和无复发生存的独立危险因素。生存分析采用Kaplan-Meier法和Log-rank检验。多因素分析采用Cox比例风险回归模型。

结果

患者中位生存期为18个月，1、2、3年累积生存率分别为62.5%、43.5%、33.5%。患者中位无复发生存期为6个月，1、2、3年无复发生存率为37.5%、18.2%、10.9%。多因素分析显示，癌栓分级（RR=4.632，95%CI：1.528～14.039；P<0.05）、手术方式（RR=4.928，95%CI：1.233～19.696；P<0.05）和复发后采取措施（RR=21.069，95%CI：3.529～125.806；P<0.05）是患者术后总体生存率的独立影响因素；采取预防复发措施是患者术后无复发生存率的独立影响因素（RR=4.486，95%CI：1.807～11.138；P<0.05）。

结论

手术治疗对于肝癌合并门静脉癌栓有一定的临床应用价值，癌栓分级、手术方式和复发后采取措施是患者术后总体生存的独立影响因素，而采取预防复发措施是患者术后无复发生存的独立影响因素。

关键词: 癌，肝细胞, 肿瘤细胞，循环, 肝切除术, 存活率
Objective

To investigate the influencing factors for the prognosis of patients with hepatocellular carcinoma (HCC) complicated with portal vein tumor thrombus (PVTT) after surgical treatment.

Methods

Clinical data of 32 patients with HCC and PVTT who underwent surgical treatments in Tianjin Medical University Cancer Institute and Hospital between June 2010 and June 2013 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 25 males and 7 females, aged from 35 to 75 years old with a median age of 66 years old. The 1-, 2-, 3-year cumulative survival and recurrence-free survival of the patients were observed, and independent risk factors for the overall and recurrence-free survival were analyzed. Survival analysis was conducted using Kaplan-Meier method and Log-rank test. Multivariate analysis was conducted using Cox proportional hazard regression model.

Results

The median survival time was 18 months, and the 1-, 2- , 3-year cumulative survival was respectively 62.5%, 43.5% and 33.5%. The median recurrence-free survival time was 6 months, and the 1-, 2-, 3-year recurrence-free survival was respectively 37.5%, 18.2% and 10.9%. Multivariate analysis revealed that PVTT staging (RR=4.632, 95%CI: 1.528-14.039; P<0.05), surgical procedure (RR=4.928, 95%CI:1.233-19.696; P<0.05) and treatments after recurrence (RR=21.069, 95%CI:3.529-125.806; P<0.05) were the independent influencing factors for postoperative overall survival. Treatments to prevent recurrence was the independent influencing factor for postoperative recurrence-free survival (RR=4.486, 95%CI: 1.807-11.138; P<0.05).

Conclusions

Surgical treatments has certain clinical application value for HCC complicated with PVTT. PVTT staging, surgical procedure and treatments after recurrence are the independent influencing factors for postoperative overall survival. And treatments to prevent recurrence is the independent influencing factor for postoperative recurrence-free survival.

Key words: Carcinoma, hepatocellular, Neoplastic cells, circulating, Hepatectomy, Survival rate
表1 肝癌合并门静脉癌栓患者手术治疗后总体生存率的单因素分析
参数 例数 总体生存率（%） χ 2值 P值 无复发生存在率（%） χ 2值 P值
1年 2年 3年 1年 2年 3年
AFP（μg/L） ? ? ? ? 0.072 0.788 ? ? ? 3.206 0.073
? < 400 11 63.6 43.6 32.7 ? ? 54.5 43.6 21.8 ? ?
? ≥400 21 57.1 38.1 33.3 ? ? 57.1 38.1 23.8 ? ?
肿瘤数量 ? ? ? ? 5.887 0.015 ? ? ? 4.619 0.032
? 单发 27 66.7 47.9 39.9 ? ? 40.7 21.6 13.0 ? ?
? 多发 5 20.0 20.0 20.0 ? ? 20.0 20.0 20.0 ? ?
肿瘤直径（cm） ? ? ? ? 0.330 0.566 ? ? ? 0.024 0.877
? < 5 5 60.0 40.0 0.0 ? ? 40.0 0 0 ? ?
? ≥5 27 59.3 44.4 37.0 ? ? 33.3 18.5 11.1 ? ?
肿瘤包膜 ? ? ? ? 1.126 0.289 ? ? ? 2.355 0.125
? 有 1 - - - ? ? - - - ? ?
? 无 31 61.3 41.7 31.3 ? ? 35.5 15.5 7.7 ? ?
卫星灶 ? ? ? ? 1.534 0.215 ? ? ? 0.093 0.761
? 有 19 63.2 47.4 42.1 ? ? 36.8 21.1 10.5 ? ?
? 无 13 53.8 28.8 19.2 ? ? 30.8 15.4 15.4 ? ?
微血管侵犯 ? ? ? ? 0.014 0.907 ? ? ? 0.360 0.548
? 有 28 60.7 42.6 34.8 ? ? 35.7 17.1 8.6 ? ?
? 无 4 50.0 25.0 25.0 ? ? 25.0 25.0 25.0 ? ?
肿瘤病理分级 ? ? ? ? 1.657 0.647 ? ? ? 3.545 0.315
? 高分化 2 100.0 100.0 50.0 ? ? 50.0 50.0 50.0 ? ?
? 中分化 14 64.3 42.9 42.9 ? ? 42.9 21.4 14.3 ? ?
? 中-低分化 11 45.5 24.2 24.2 ? ? 27.3 0 0 ? ?
? 低分化 5 40.0 20.0 20.0 ? ? 20.0 20.0 20.0 ? ?
癌栓分级 ? ? ? ? 6.412 0.041 ? ? ? 4.938 0.085
? Ⅰ型 18 66.7 55.0 48.9 ? ? 38.9 27.8 13.9 ? ?
? Ⅱ型 11 45.5 9.1 9.1 ? ? 27.3 9.0 0 ? ?
? Ⅲ型 3 33.0 33.0 33.0 ? ? 33.0 33.0 33.0 ? ?
手术方式 ? ? ? ? 6.315 0.044 ? ? ? 3.566 0.059
? 肿瘤+癌栓整块切除 24 70.8 45.5 40.9 ? ? 45.8 20.0 10.0 ? ?
? 肿瘤切除+癌栓取出 8 25.0 25.0 12.5 ? ? 12.5 12.5 12.5 ? ?
复发后措施 ? ? ? ? 14.913 0.000 ? ? ? - -
? 有 18 72.0 55.6 38.9 ? ? - - - ? ?
? 无 10 20.0 0 0 ? ? - - - ? ?
预防复发措施 ? ? ? ? 14.913 0.000 ? ? ? 16.411 0.000
? 有 20 - - - ? ? 50.0 29.2 17.5 ? ?
? 无 12 - - - ? ? 8.3 0 0 ? ?
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