单个大肝细胞癌肝切除术后预后评分系统的建立

doi:10.3877/cma.j.issn.2095-3232.2018.03.008

中华肝脏外科手术学电子杂志 ›› 2018, Vol. 07 ›› Issue (03) : 197 -201. doi: 10.3877/cma.j.issn.2095-3232.2018.03.008

所属专题：文献；

临床研究

单个大肝细胞癌肝切除术后预后评分系统的建立

沈俊颐¹, 李川¹, 文天夫¹^,^†(

), 严律南¹, 杨家印¹, 曾勇¹, 吴泓¹, 王文涛¹, 徐明清¹, 陈哲宇¹, 魏永刚¹, 蒋利¹, 黄纪伟¹

^1. 610041　成都，四川大学华西医院肝脏外科及肝脏移植中心

收稿日期:2018-03-09 出版日期:2018-06-10
通信作者: 文天夫
基金资助:
四川省科技支撑计划项目(2015S20049，2016S20025)

Establishment of prognostic scoring system for single large hepatocellular carcinoma after hepatectomy

Junyi Shen¹, Chuan Li¹, Tianfu Wen¹^,^†(), lvnan Yan¹, Jiayin Yang¹, Yong Zeng¹, Hong Wu¹, Wentao Wang¹, Mingqing Xu¹, Zheyu Chen¹, Yonggang Wei¹, Li Jiang¹, Jiwei Huang¹

^1. Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, China

Received:2018-03-09 Published:2018-06-10
Corresponding author: Tianfu Wen
About author:
Corresponding author: Wen Tianfu, Email: tianfu1962@163.com

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引用本文：

沈俊颐, 李川, 文天夫, 严律南, 杨家印, 曾勇, 吴泓, 王文涛, 徐明清, 陈哲宇, 魏永刚, 蒋利, 黄纪伟. 单个大肝细胞癌肝切除术后预后评分系统的建立[J]. 中华肝脏外科手术学电子杂志, 2018, 07(03): 197-201.

Junyi Shen, Chuan Li, Tianfu Wen, lvnan Yan, Jiayin Yang, Yong Zeng, Hong Wu, Wentao Wang, Mingqing Xu, Zheyu Chen, Yonggang Wei, Li Jiang, Jiwei Huang. Establishment of prognostic scoring system for single large hepatocellular carcinoma after hepatectomy[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2018, 07(03): 197-201.

目的

建立单个大肝细胞癌（肝癌）肝切除术后患者预后的临床评分系统。

方法

本前瞻性研究对象为2009年1月至2013年12月在四川大学华西医院行肝切除术的268例单个大肝癌患者。其中男227例，女41例；年龄≤60岁198例，>60岁70例。患者均签署知情同意书，符合医学伦理学规定。观察患者生存预后情况，采用Cox比例风险回归模型筛选单个大肝癌术后预后的独立危险因素，根据危险因素构建单个大肝癌术后预后评分系统，并采用Kaplan-Meier法和Log-rank检验生存分析对该评分系统进行验证。

结果

患者中位术后总生存时间为45个月，无瘤生存时间31个月。血小板/淋巴细胞比值（PLR）≥107、肿瘤直径≥6.8 cm和微血管侵犯（MVI）阳性是影响单个大肝癌患者术后总生存时间和无瘤生存时间的独立危险因素（HR=1.004，1.092，2.233和1.003，1.062，1.534；P<0.05）。任意一个独立危险因素均赋值1分，最终分为低危组（0分），中危组（1～2）分，高危组（3分）。高危组患者5年生存率为25.4%，中危、低危组患者分别为33.2%、52.1%，差异有统计学意义（χ²=23.1，P<0.05）。评分系统在非肝硬化组和肝硬化组患者应用中均有类似结果。

结论

PLR≥107、肿瘤直径≥6.8 cm和MVI阳性是单个大肝癌切除术后预后的独立危险因素。本研究建立的预后评分系统可用于预测患者术后远期生存情况。

关键词: 癌，肝细胞, 预后, 肝切除术, 微血管侵犯, 血小板/淋巴细胞比值

Objective

To establish a clinical scoring system for the prognosis of patients with single large hepatocellular carcinoma (HCC) after hepatectomy.

Methods

268 patients with single large HCC who underwent hepatectomy in West China Hospital of Sichuan University from January 2009 to December 2013 were included in this prospective study. There were 227 males and 41 females, of which 198 cases aged ≤60 years old, 70 aged>60 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. The patients' survival were observed. The independent risk factors for postoperative prognosis of patients with single large HCC were selected by Cox proportional risk regression mode. Based on the risk factors, the prognostic scoring system for single large HCC was established. The scoring system was tested through survival analysis by Kaplan-Meier and Log-rank test.

Results

The median overall postoperative survival was 45 months, and the tumor-free survival was31 months. Platelet-to-lymphocyte ratio (PLR)≥107, tumor diameter≥6.8 cm and positive microvascular invasion (MVI) were the independent risk factors for postoperative overall survival and tumor-free survival in patients with single large HCC (HR=1.004, 1.092, 2.233 and 1.003, 1.062, 1.534; P<0.05). Every independent risk factor was assigned 1 point. All patients were divided into low risk group (0 point), moderate risk group (1-2 points) and high risk group (3 points). The 5-year survival rate of high risk group was 25.4%, and that of moderate and low risk group was 33.2% and 52.1% respectively, where significant difference was observed (χ²=23.1, P<0.05). Similar results were observed when the scoring system was used in patients with or without cirrhosis.

Conclusions

PLR ≥107, tumor diameter ≥6.8 cm and positive MVI are the independent risk factors for the prognosis of patients with single large HCC after resection. The prognostic scoring system established in this study can be used to predict the postoperative long-term survival of patients.

Key words: Carcinoma, hepatocelluar, Prognosis, Hepatectomy, Microvascular invasion, Platelet-to-lymphocyte ratio

表1 268例大肝癌患者临床病理学资料

变量		例数	百分率（%）
症状（例）		?	?
?	无	169	63.1
?	有	99	26.9
HBsAg（例）		?	?
?	阴性	40	14.9
?	阳性	228	85.1
HBV-DNA阳性（例）		?	?
?	阴性	150	56.0
?	阳性	118	44.0
AFP（例）		?	?
?	≤800 μg/L	182	67.9
?	> 800 μg/L	86	39.2
ALB（g/L，±s）		41±4	-
NLR（±s）		2.8±1.4	-
PLR（±s）		118±65	-
肿瘤直径（cm，±s）		9±3	-
MVI（例）		?	?
?	阴性	182	67.9
?	阳性	86	32.1
分化程度（例）		?	?
?	低分化	106	39.1
?	中高分化	162	60.4
Ishak score≥5（例）		153	57.1
术中输血（例）		?	?
?	无	233	86.9
?	有	35	13.1

表1 268例大肝癌患者临床病理学资料

变量		例数	百分率（%）
症状（例）		?	?
?	无	169	63.1
?	有	99	26.9
HBsAg（例）		?	?
?	阴性	40	14.9
?	阳性	228	85.1
HBV-DNA阳性（例）		?	?
?	阴性	150	56.0
?	阳性	118	44.0
AFP（例）		?	?
?	≤800 μg/L	182	67.9
?	> 800 μg/L	86	39.2
ALB（g/L，±s）		41±4	-
NLR（±s）		2.8±1.4	-
PLR（±s）		118±65	-
肿瘤直径（cm，±s）		9±3	-
MVI（例）		?	?
?	阴性	182	67.9
?	阳性	86	32.1
分化程度（例）		?	?
?	低分化	106	39.1
?	中高分化	162	60.4
Ishak score≥5（例）		153	57.1
术中输血（例）		?	?
?	无	233	86.9
?	有	35	13.1

表2 单个大肝癌切除患者术后生存影响因素多因素Cox回归分析

变量	总体生存			无瘤生存
变量	HR	95%CI	P	HR	95%CI	P
PLR	1.004	1.001～1.006	0.003	1.003	1.001～1.006	0.003
肿瘤直径	1.092	1.044～1.142	0.001	1.062	1.020～1.106	0.004
MVI	2.233	1.125～2.233	0.008	1.534	1.136～2.071	0.005

表2 单个大肝癌切除患者术后生存影响因素多因素Cox回归分析

变量	总体生存			无瘤生存
变量	HR	95%CI	P	HR	95%CI	P
PLR	1.004	1.001～1.006	0.003	1.003	1.001～1.006	0.003
肿瘤直径	1.092	1.044～1.142	0.001	1.062	1.020～1.106	0.004
MVI	2.233	1.125～2.233	0.008	1.534	1.136～2.071	0.005

图1 单个大肝癌切除低危、中危、高危组患者术后Kaplan-Meier生存曲线

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Establishment of prognostic scoring system for single large hepatocellular carcinoma after hepatectomy

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Establishment of prognostic scoring system for single large hepatocellular carcinoma after hepatectomy