探讨BCLC-B期和C期肝细胞癌（肝癌）患者预后影响因素及手术治疗价值。

回顾性分析2011年6月至2013年6月在华中科技大学同济医学院附属同济医院诊治的110例BCLC-B期和C期肝癌患者临床资料。其中男98例，女12例；年龄19~74岁，中位年龄51岁。患者均签署知情同意书，符合医学伦理学规定。预后影响因素分析采用Cox比例风险回归模型，生存分析采用Kaplan-Meier法和Log-rank检验。

BCLC-B期患者52例，24例行手术治疗，28例行非手术治疗，其中TACE 27例，微波消融1例。BCLC-C期患者58例，32例行手术治疗，26例行非手术治疗，其中TACE 23例，口服索拉非尼3例。Cox分析结果显示，年龄、终末期肝病模型（MELD）评分、肝硬化是BCLC-B期肝癌患者总体生存的独立影响因素（HR=0.311，5.083，0.355；P<0.05）。ALP、门静脉肉眼癌栓、治疗方式是BCLC-C期肝癌患者总体生存的独立影响因素（HR=2.027，2.908，0.321；P<0.05）。BCLC-C期手术患者中位生存时间12个月，非手术患者5个月，手术患者具有明显生存优势（χ²=23.59，P<0.05）。门静脉主干癌栓和分支癌栓患者的术后中位生存时间分别为4、11个月，门静脉主干癌栓患者生存情况较差（χ²=14.70，P<0.05）。

BCLC-C期肝癌手术疗效优于非手术治疗，且门静脉分支癌栓患者手术疗效优于门静脉主干癌栓患者。对于BCLC-B期肝癌患者，年龄、MELD评分、肝硬化是生存预后独立影响因素，而与治疗方式无关。

To investigate the prognostic factors and the value of surgical treatment in patients with BCLC-B or C stage hepatocellular carcinoma (HCC).

Clinical data of 110 patients with BCLC-B or C stage HCC admitted to Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from June 2011 to June 2013 were retrospectively analyzed. Among them, 98 patients were male and 12 female, aged 19-74 years with a median age of 51 years. The informed consents of all patients were obtained and the local ethical committee approval was received. The prognostic factors were analyzed by Cox proportional hazards regression model. Survival analysis was conducted with Kaplan-Meier and Log-rank test.

Among the 52 patients with BCLC-B stage HCC, 24 cases received surgical treatments and 28 received non-surgical treatments including TACE in 27 cases, microwave ablation in 1 case. Of the 58 patients with BCLC-C stage HCC, 32 cases underwent surgery and 26 received non-surgical treatments including TACE in 23 patients, oral sorafenib in 3 cases. Cox proportional hazards regression analysis demonstrated that age, model for end-stage liver disease (MELD) score and liver cirrhosis were the independent factors affecting the overall survival of BCLC-B stage HCC patients (HR=0.311, 5.083, 0.355; P<0.05). ALP, macroscopic portal vein tumor thrombus and treatment method were the independent factors affecting the overall survival of BCLC-C stage HCC patients (HR=2.027, 2.908, 0.321; P<0.05). The median survival time of BCLC-C stage HCC patients undergoing surgery was 12 months, significantly better than5 months of those undergoing non-surgical treatments (χ²=23.59, P<0.05). The median survival time of patients with tumor thrombus in the main portal vein was 4 months, significantly worse than 11 months of those with tumor thrombus in the portal branch vein (χ²=14.70, P<0.05).

The efficacy of surgical treatment is better than that of non-surgical treatments for patients with BCLC-C stage HCC. And patients with tumor thrombus in the portal branch vein have better surgical efficacy than those with tumor thrombus in the main portal vein. Age, MELD score and liver cirrhosis, rather than treatment method, are the independent factors affecting the survival and prognosis of patients with BCLC-B stage HCC.