肝细胞癌微血管侵犯的危险因素及其对预后的影响分析
作者:
作者单位:

1.中国人民解放军联勤保障部队第九〇四医院 肝胆外科,江苏 无锡 214044;2.安徽医科大学无锡临床学院 肝胆外科,江苏 无锡 214044

作者简介:

谢伟选,中国人民解放军联勤保障部队第九〇四医院住院医师,主要从事肝胆外科方面的研究。

通信作者:

罗昆仑,Email: xwx19930428@163.com

基金项目:

安徽医科大学校科研基金资助项目(2021xkj120)。


Analysis of risk factors for and prognostic significance of microvascular invasion in hepatocellular carcinoma
Author:
Affiliation:

1.Department of Hepatobiliary Surgery, the 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, Jiangsu 214044, China;2.Department of Hepatobiliary Surgery, Wuxi Clinical School of Anhui Medical University, Wuxi, Jiangsu 214044, China

Fund Project:

  • 摘要
  • |
  • 图/表
  • |
  • 访问统计
  • |
  • 参考文献
  • |
  • 相似文献
  • |
  • 引证文献
  • |
  • 资源附件
  • |
  • 音频文件
  • |
  • 视频文件
    摘要:

    背景与目的 肝细胞癌(HCC)在我国属于较常见的恶性肿瘤,根治性切除是其首选治疗方式,但是术后复发仍然严重影响患者的预后。在众多影响因素中,微血管侵犯(MVI)被认为是HCC患者术后复发风险的重要预测指标。因此,本研究探讨HCC患者MVI的危险因素及MVI对根治术术后预后的影响,以期为临床治疗提供更多的参考指标。方法 回顾性收集2017年2月—2020年2月中国人民解放军联勤保障部队第九〇四医院肝胆外科收治的150例行HCC根治术患者的临床病理资料。病理检查证实42例有MVI,108例无MVI,通过两组患者的临床数据分析MVI的影响因素,通过随访数据分析两组患者术后的生存情况。结果 单变量分析结果显示,肿瘤最大直径、术前甲胎蛋白(AFP)、术前血小板(PLT)与HCC患者MVI发生有关(均P<0.05)。多变量分析结果显示,肿瘤最大直径(>5 cm)、术前AFP(≥400 μg/L)、术前PLT(>200×109/L)也是HCC患者MVI发生的独立危险因素(均P<0.05)。150例患者均获得随访,随访时间范围12~48个月,中位时间为26个月。与无MVI患者比较,有MVI患者术后1、2年总体生存率明显降低(76.19% vs. 91.67%,P<0.05;47.20% vs. 78.70%,P<0.05),中位生存时间明显缩短(23个月 vs. 34个月,P<0.05)。结论 肿瘤较大、术前AFP与PLT水平较高的HCC患者发生MVI的风险升高,对于此类患者应进行严格的术后随访,以便一旦出现复发征象及时进行后续治疗,改善患者生存。

    Abstract:

    Background and Aims Hepatocellular carcinoma (HCC) is a relatively common malignant tumor in China, for which, radical resection is the primary treatment option, but the postoperative recurrence still seriously affects patients' prognosis. Among various influencing factors, microvascular invasion (MVI) is considered to be an important indicator for postoperative recurrence in HCC patients. Therefore, this study was performed to investigate the risk factors for MVI in HCC patients and the impact of MVI on prognosis of patients after radical surgery, so as to provide more complete data for clinical reference.Methods The clinicopathologic data of 150 HCC patients undergoing radical surgery at Department of Hepatobiliary Surgery, the 904th Hospital of Joint Logistic Support Force of PLA from February 2017 to February 2020 were retrospectively collected. Of the patients, 42 cases had MVI and 108 cases had no MVI as identified by pathological examination. The influencing factors for MVI were analyzed by comparison of the clinical data of the two groups of patients, and the postoperative survival status of the two groups of patients was analyzed by comparing the follow-up data.Results The results of univariate analysis showed that the maximum tumor diameter, preoperative α-fetoprotein (AFP) level, and preoperative platelet (PLT) count were significantly associated with the incidence of MVI in HCC patients (all P<0.05). The results of multivariate analysis revealed that the maximum tumor diameter (>5 cm), preoperative AFP level (≥400 μg/L), and preoperative PLT count (>200×109/L) were also independent risk factors for MVI in HCC patients (all P<0.05). Follow-up was conducted in all the 150 patients for 12 to 48 months with a median time of 26 months. In patients with MVI compared with those without MVI, the 1- and 2-year overall survival rates were significantly decreased (76.19% vs. 91.67%, P<0.05, 47.20% vs.78.70%, P<0.05), and the median survival time was significantly shortened (23 months vs. 34 months, P<0.05).Conclusion The risk of MVI is increased in HCC patients with relatively large tumor size, high preoperative AFP level and high preoperative PLT count. For these patients, rigorous postoperative follow-up should be performed, so that subsequent treatment can be provided timely to improve their survival as soon as they develop signs of recurrence.

    表 2 HCC患者MVI影响因素的多变量分析Table 2 Multivariate analysis of influencing factors for MVI in HCC patients
    表 1 HCC患者MVI影响因素的单变量分析[n (%)]Table 1 Univariate analysis of influencing factors for MVI in HCC patients [n (%)]
    图1 MVI和无MVI患者行HCC根治术后的总体生存曲线Fig.1 Overall survival curves for HCC patients with and without MVI after radical surgery
    参考文献
    相似文献
    引证文献
引用本文

谢伟选,柏杨,方征,朱庆洲,罗昆仑.肝细胞癌微血管侵犯的危险因素及其对预后的影响分析[J].中国普通外科杂志,2022,31(7):890-895.
DOI:10.7659/j. issn.1005-6947.2022.07.005

复制
分享
文章指标
  • 点击次数:
  • 下载次数:
历史
  • 收稿日期:2022-04-14
  • 最后修改日期:2022-06-17
  • 录用日期:
  • 在线发布日期: 2022-07-31