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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 ›› 2017, Vol. 06 ›› Issue (03) : 207 -211. doi: 10.3877/cma.j.issn.2095-3232.2017.03.013

所属专题： 文献；

临床研究

微血管侵犯对小肝细胞癌和大肝细胞癌术后远期预后的影响
白石磊1, 杨平华1, 李俊1, 沈锋1,†()   
  1. 1. 200438　上海，第二军医大学附属东方肝胆外科医院肝胆外科
  • 收稿日期:2017-02-10 出版日期:2017-06-10
  • 通信作者: 沈锋
  • 基金资助:
    国家科技重大专项(2012ZX10002-016)

Effect of microvascular invasion on postoperative long-term prognosis of small and large hepatocellular carcinoma

Shilei Bai1, Pinghua Yang1, Jun Li1, Feng Shen1,†()   

  1. 1. Department of hepatobiliary surgery, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, Shanghai 200438, China
  • Received:2017-02-10 Published:2017-06-10
  • Corresponding author: Feng Shen
  • About author:
    Corresponding author: Shen Feng, Email:
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白石磊, 杨平华, 李俊, 沈锋. 微血管侵犯对小肝细胞癌和大肝细胞癌术后远期预后的影响[J]. 中华肝脏外科手术学电子杂志, 2017, 06(03): 207-211.

Shilei Bai, Pinghua Yang, Jun Li, Feng Shen. Effect of microvascular invasion on postoperative long-term prognosis of small and large hepatocellular carcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2017, 06(03): 207-211.

目的

探讨微血管侵犯（MVI）对小肝细胞癌（肝癌）和大肝癌患者术后远期预后的影响。

方法

回顾性分析2008年1月至2008年7月在第二军医大学附属东方肝胆外科医院行根治性肝切除术的549例肝癌患者临床资料。其中男467例，女82例；年龄≤60岁426例，>60岁123例。根据肿瘤直径将患者分为小肝癌组（直径≤5 cm，319例）和大肝癌组（直径>5 cm，230例）。患者均签署知情同意书，符合医学伦理学规定。生存分析采用Kaplan-Meier生存曲线，肝癌术后远期生存的影响因素分析采用Cox比例风险回归模型。

结果

小肝癌组MVI（-）患者术后1、3、5年无瘤生存率和总体生存率分别为76%、55%、44%和95%、77%、62%，明显高于MVI（+）患者的53%、30%、27%和82%、50%、37%（χ2=12.767，18.937；P<0.05）。大肝癌组MVI（-）患者术后1、3、5年无瘤生存率和总体生存率分别为59%、40%、36%和82%、55%、41%，明显高于MVI（+）患者的35%、14%、14%和67%、42%、26%（χ2=20.378，9.733；P<0.05）。多因素分析结果显示，小肝癌组肿瘤数量、MVI和Edmondson-Steiner分级是患者术后无瘤生存的独立影响因素（HR=1.86，1.46，1.49；P<0.05）；CA19-9、MVI、Edmondson-Steiner分级是患者术后总体生存的独立影响因素（HR=2.07，1.85，1.52；P<0.05）。大肝癌组MVI和肿瘤直径是患者术后无瘤生存的独立影响因素（HR=2.01，1.05；P<0.05）；AFP、MVI和肿瘤直径是患者术后总体生存的独立影响因素（HR=1.75，1.46，1.06；P<0.05）。

结论

MVI是影响小肝癌和大肝癌患者术后无瘤生存和总体生存的独立危险因素。

关键词: 癌，肝细胞, 微血管侵犯, 存活率, 危险因素, 预后
Objective

To investigate the effect of microvascular invasion (MVI) on postoperative long-term prognosis of the patients with small and large hepatocellular carcinoma (HCC).

Methods

Clinical data of 549 patients who underwent radical hepatectomy in the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University between January 2008 and July 2008 were retrospectively analyzed. Among the patients, 467 cases were males and 82 females, 426 cases aged ≤60 years old and 123 aged >60 years old. According to the tumor diameter, the patients were divided into the small HCC group (tumor diameter ≤5 cm, n=319) and large HCC group (tumor diameter> 5 cm, n=230). The informed consents of all patients were obtained and the local ethical committee approval was received. Survival analysis was performed using Kaplan-Meier survival curve. Risk factors of postoperative long-term survival were analyzed using Cox proportional hazard regression model.

Results

In the small HCC group, the postoperative 1-, 3-, 5-year tumor-free survival rate and overall survival rate of the patients with MVI (-) was respectively 76%, 55%, 44% and 95%, 77%, 62%, significantly higher than 53%, 30%, 27% and 82%, 50%, 37% of the patients with MVI (+) (χ2=12.767, 18.937; P<0.05). In the large HCC group, the postoperative 1-, 3-, 5-year tumor-free survival rate and overall survival rate of the patients with MVI (-) was respectively 59%, 40%, 36% and 82%, 55%, 41%, significantly higher than 35%, 14%, 14% and 67%, 42%, 26% of the patients with MVI (+) (χ2=20.378, 9.733; P<0.05). Multivariate analysis indicated that, in the small HCC group, the tumor number, MVI and Edmondson-Steiner grade were the independent influence factors for postoperative tumor-free survival (HR=1.86, 1.46, 1.49; P<0.05), and CA19-9, MVI and Edmondson-Steiner grade were the independent influence factors for postoperative overall survival (HR=2.07, 1.85, 1.52; P<0.05). In the large HCC group, MVI and tumor diameter were the independent influence factors for postoperative tumor-free survival (HR=2.01, 1.05; P<0.05), and AFP, MVI and tumor diameter were the independent influence factors for postoperative overall survival (HR=1.75, 1.46, 1.06; P<0.05).

Conclusion

MVI is an independent risk factor for postoperative tumor-free survival and overall survival of patients with small and large HCC.

Key words: Carcinoma Hepatocellular, Microvascular invasion, Survival rate, Risk factor, Prognosis
表1 小肝癌组患者临床病理学特征（例）
组别 例数 性别 年龄 Plt ALT ALB TB
男 女 ≤60岁 >60岁 ≤100×109/L >100×109/L ≤44 U/L >44U/L ≤35 g/L >35 g/L <17 μmol/L ≥17 μmol/L
MVI(-) 247 206 41 183 64 60 187 163 84 14 233 172 75
MVI(+) 72 62 10 57 15 18 54 48 24 7 65 51 21
χ2 ? 0.035 0.771 0.015 0.011 1.490 0.038
P ? >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
组别 例数 PT HBsAg HBV-DNA AFP CA19-9 CEA
≤13 s >13 s （-） （+） <104 IU/ml ≥104 IU/ml ≤20 μg/L >20 μg/L ≤39 μg/L >39 μg/L ≤5 μg/L >5 μg/L
MVI(-) 247 205 42 37 210 154 93 124 123 208 39 225 22
MVI(+) 72 60 12 5 37 35 37 19 53 51 21 65 7
χ2 ? 0.005 3.148 4.357 12.783 6.533 0.045
P ? >0.05 >0.05 <0.05 <0.05 <0.05 >0.05
组别 例数 术中输血 肿瘤数量 肿瘤包膜 肝硬化 Edmonson-Steiner分级
无 有 单发 多发 不完整 完整 无 有 无 有
MVI(-) 247 60 187 222 25 173 74 91 156 104 143
MVI(+) 72 18 54 60 12 38 34 14 58 10 62
χ2 ? 0.023 2.329 7.419 7.642 19.327
P ? >0.05 >0.05 <0.05 <0.05 <0.05
图1 小肝癌组和大肝癌组MVI（-）和MVI（+）患者Kaplan-Meier无瘤生存曲线
表2 大肝癌组患者术后生存预后的Cox比例风险回归模型多因素分析
变量 无瘤生存 总体生存
b SE(b) waldχ2 HR 95%CI P b SE(b) waldχ2 HR 95%CI P
AFP 0.255 0.185 1.904 1.29 0.89～1.85 0.168 0.560 0.220 6.509 1.75 1.13～2.69 0.011
MVI 0.702 0.169 17.151 2.01 1.44～2.81 <0.001 0.379 0.183 4.298 1.46 1.02～2.09 0.038
Edmondson Steiner分级 - - - - - - 0.293 0.267 1.207 1.34 0.79～2.26 0.272
肿瘤直径 0.057 0.021 7.626 1.05 1.01～1.10 0.006 0.067 0.022 9.462 1.06 1.02～1.11 0.002
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