探讨肝纤维化指标S指数对符合米兰标准的肝癌合并慢性乙型病毒性肝炎（CHB）患者根治性肝切除术后复发和生存的预测价值。

回顾性分析2013年1月至2015年12月在华中科技大学同济医学院附属同济医院行根治性切除术的287例符合米兰标准的肝癌合并CHB患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男248例，女39例；年龄22～78岁，中位年龄为51岁。采用ROC曲线确定S指数的最佳界值，根据最佳界值分组。生存分析采用Kaplan-Meier法和Log-rank检验。采用Cox比例风险回归模型行预后单因素和多因素分析。

S指数≤0.16组（低S指数组）患者术后1、3、5年无瘤生存率分别为90.1%、73.6%、62.4%，S指数>0.16组（高S指数组）相应为80.7%、52.4%和40.8%；低S指数组术后1、3、5年总体生存率分别为97.5%、86.0%、81.1%，高S指数组相应为95.2%、72.9%、60.7%；高S指数患者术后无瘤生存率和总体生存率较差（HR=1.994，2.687；P <0.05）。Cox多因素分析显示，S指数>0.16是患者术后无瘤生存和总体生存的独立危险因素（HR=1.837，2.309；P <0.05）。

S指数可作为临床预测符合米兰标准的肝癌合并CHB患者预后的一项参考指标，S指数>0.16提示术后复发率高，患者预后较差。

To evaluate the predictive value of liver fibrosis indicator S index for the recurrence and survival of patients with liver cancer meeting Milan criteria complicated with chronic hepatitis B (CHB) after radical hepatectomy.

Clinical data of 287 patients with liver cancer meeting Milan criteria complicated with CHB who underwent radical hepatectomy in Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science & Technology from January 2013 to December 2015 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 248 patients were male and 39 female, aged from 22 to 78 years, with a median age of 51 years. The optimal cut-off value of S index was determined by the receiver operating characteristic (ROC) curve. All patients were divided into two groups according to the optimal cut-off value. Survival analysis was performed by Kaplan-Meier method and Log-rank test. Cox's proportional hazards regression model was used for univariate and multivariate analyses of clinical prognosis.

The postoperative 1-, 3- and 5-year disease-free survival of patients with S index≤0.16 (low S index group) were 90.1%, 73.6% and 62.4%, and were 80.7%, 52.4% and 40.8% in patients with S index > 0.16 (high S index group). The postoperative 1-, 3- and 5-year overall survival in low S index group were 97.5%, 86.0% and 81.1%, and were 95.2%, 72.9% and 60.7% in high S index group. The postoperative disease-free survival and overall survival of patients with high S index after hepatectomy were significantly worse compared with those with low S index (HR=1.994, 2.687; P<0.05). Cox's multivariate analysis showed that S index > 0.16 was an independent risk factor for the postoperative tumor-free survival and overall survival of patients (HR=1.837, 2.309; P<0.05).

S index can serve asa reference parameter to predict the prognosis of patients with liver cancer meeting Milan criteria complicated with CHB. S index > 0.16 indicates high recurrence rate and poor clinical prognosis.