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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 ›› 2018, Vol. 07 ›› Issue (03) : 211 -215. doi: 10.3877/cma.j.issn.2095-3232.2018.03.011

所属专题： 文献；

临床研究

伴门静脉高压症的肝细胞癌患者射频消融治疗预后分析
袁廷东1, 邹浩1, 何兵1, 杨振鹏1, 吴力群1,†()   
  1. 1. 266003　青岛大学附属医院肝胆胰外科
  • 收稿日期:2018-03-14 出版日期:2018-06-10
  • 通信作者: 吴力群
  • 基金资助:
    山东省重点研发计划(2016GGB14019)

Prognostic analysis for patients with hepatocellular carcinoma complicated with portal hypertension after radiofrequency ablation

Tingdong Yuan1, Hao Zou1, Bing He1, Zhenpeng Yang1, Liqun Wu1,†()   

  1. 1. Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
  • Received:2018-03-14 Published:2018-06-10
  • Corresponding author: Liqun Wu
  • About author:
    Corresponding author: Wu Liqun, Email:
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袁廷东, 邹浩, 何兵, 杨振鹏, 吴力群. 伴门静脉高压症的肝细胞癌患者射频消融治疗预后分析[J]. 中华肝脏外科手术学电子杂志, 2018, 07(03): 211-215.

Tingdong Yuan, Hao Zou, Bing He, Zhenpeng Yang, Liqun Wu. Prognostic analysis for patients with hepatocellular carcinoma complicated with portal hypertension after radiofrequency ablation[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2018, 07(03): 211-215.

目的

探讨伴门静脉高压症（PHT）的肝细胞癌（肝癌）患者行射频消融（RFA）治疗的预后及其影响因素分析。

方法

回顾性分析2011年1月至2015年12月在青岛大学附属医院首次行RFA治疗的223例肝癌患者临床资料。其中男168例，女55例；年龄31～80岁，中位年龄57岁。根据有无PHT，将患者分为PHT组和无PHT组。患者均签署知情同意书，符合医学伦理学规定。超声或CT引导下进行RFA治疗，并对患者进行术后随访。生存分析采用Kaplan-Meier法和Log-rank检验，多因素分析采用Cox回归风险模型。

结果

患者中位随访时间为38 （8～79）个月。Kaplan-Meier分析结果显示，PHT组患者1、2、5年无瘤生存率分别为85.8%、67.7%和43.8%，无PHT组患者相应为90.0%、79.9%和62.1%，差异有统计学意义（χ2=8.357，P<0.05）。PHT组患者1、2、5年总体生存率分别为100.0%、93.7%和68.9%，无PHT组相应为99.1%、97.2%和91.7%，差异有统计学意义（χ2=6.013，P<0.05）。AFP>100 μg/L是伴PHT的肝癌患者RFA治疗后无瘤生存的独立危险因素（HR=1.824，P<0.05）。术前酗酒是伴PHT的肝癌患者RFA治疗后总体生存的独立危险因素（HR=2.724，P<0.05）。

结论

伴PHT的肝癌患者RFA治疗后无瘤生存率和总体生存率明显低于无PHT的肝癌患者，术前AFP升高是其无瘤生存的独立危险因素，术前酗酒则是其总体生存的独立危险因素。

关键词: 癌，肝细胞, 高血压，门静脉, 导管消融术, 预后
Objective

To investigate the prognosis and its influencing factors for patients with hepatocellular carcinoma (HCC) complicated with portal hypertension (PHT) after radiofrequency ablation (RFA).

Methods

Clinical data of 223 patients with HCC who were treated with RFA for the first time in the Affiliated Hospital of Qingdao University from January 2011 to December 2015 were retrospectively analyzed. There were 168 males and 55 females, aged from 31 to 80 years old with the median of 57 years old. The patients were divided into PHT group and non PHT group according to whether they were complicated with PHT or not. The informed consents of all patients were obtained and the local ethical committee approval was received. RFA was performed under the guidance of ultrasound or CT, and the patients were followed up after operation. Survival analysis was conducted by Kaplan-Meier and Log-rank tests, and multivariate analysis was conducted by Cox hazard regression model.

Results

The median follow-up time of the patients was 38(8-79) months. The results of Kaplan-Meier analysis showed that the 1-, 2-, 5-year tumor free survival rates of PHT group were 85.8%, 67.7%, 43.8% respectively, and those of non PHT group were 90.0%, 79.9% and 62.1% correspondingly, and significant difference was observed (χ2=8.357, P<0.05). The 1-, 2-, 5-year overall survival rates of PHT group were 100.0%, 93.7% and 68.9% respectively, and those of non PHT group were 99.1%, 97.2% and 91.7% correspondingly, and significant difference was observed (χ2=6.013, P<0.05). AFP>100 μg/L was an independent risk factor for the tumor-free survival of patients with HCC complicated with PHT after RFA treatment (HR=1.824, P<0.05). Preoperative alcoholism was an independent risk factor for the overall survival of patients with HCC complicated with PHT after RFA treatment (HR=2.724, P<0.05).

Conclusions

The tumor-free survival rate and overall survival rate of patients with PHT after RFA treatment are significantly lower than those without PHT. Preoperative AFP elevation is an independent risk factor for tumor-free survival, and preoperative alcoholism is an independent risk factor for overall survival.

Key words: Carcinoma, hepatocellular, Hypertension, portal, Catheter ablation, Prognosis
表1 PHT组和无PHT组肝癌患者一般临床资料比较（例）
临床参数 组别 χ2值 P值
PHT组 无PHT组
年龄(岁) ? ? 2.392 0.122
? ≤60 78 65 ?
? >60 35 45
性别 ? ? 0.338 0.561
? 男 87 81 ? ?
? 女 26 29
术前酗酒 ? ? 1.387 0.239
? 无 60 67 ?
? 有 53 43 ? ?
肝炎病毒感染 ? ? 8.030 0.045
? 无 7 15 ?
? HBV 97 93 ? ?
? HCV 6 1 ? ?
? HBV+HCV 3 1 ? ?
抗病毒治疗a ? ? 0.244 0.621
? 无 79 64 ?
? 有 13 13
肝功能Child-Pugh分级（级） ? ? 21.597 0.000
? A 88 108 ? ?
? B 25 2
ALT (U/L) ? ? 2.547 0.111
? ≤40 60 70 ?
? >40 53 40
AST (U/L) ? ? 7.641 0.006
? ≤40 74 90 ? ?
? >40 39 20 ? ?
ALB (g/L) ? ? 32.180 0.000
? < 35 43 7 ? ?
? ≥35 70 103
TB (μmol/L) ? ? 10.540 0.001
? ≤20 63 84 ? ?
? >20 50 26 ? ?
GGT (U/L)a ? ? 3.340 0.068
? ≤64 77 90 ?
? >64 30 20
CRP (mg/L)a ? ? 0.118 0.731
? ≤5 86 70 ? ?
? >5 6 6
表2 PHT组和无PHT组肝癌患者肿瘤及手术相关资料比较（例）
临床参数 组别 χ2值 P值
PHT组 无PHT组
AFP（μg/L）a ? ? 3.203 0.074
? ≤100 76 85 ? ?
? >100 37 24
肿瘤直径（cm） ? ? 1.274 0.259
? ≤2.0 49 56 ? ?
? >2.0 64 54
肿瘤数量 ? ? 10.305 0.001
? 单发 89 103 ? ?
? 多发 24 7 ? ?
肝被膜侵犯a ? ? 0.249 0.618
? 无 99 93 ? ?
? 有 14 16 ? ?
消融路径 ? ? 2.320 0.314
? 经皮 16 22 ? ?
? 腹腔镜 85 81
? 开放 12 7
图1 PHT组和无PHT组肝癌患者RFA治疗后生存分析
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