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中国癌症防治杂志

中国癌症防治杂志 ›› 2022, Vol. 14 ›› Issue (1): 93-98.doi: 10.3969/j.issn.1674-5671.2022.01.16

• 临床研究 • 上一篇    下一篇

肝细胞癌患者根治性切除术后的生存影响因素分析

  

  1. 山东第一医科大学（山东省医学科学院）公共卫生学院；山东第一医科大学第二附属医院公共卫生科；山东大学第二医院循征医学中心 
  • 出版日期:2022-02-25 发布日期:2022-03-11
  • 通讯作者: 邓阳 E-mail：dengyang3417@126.com
  • 基金资助:
    山东第一医科大学省级大学生创新创业训练计划项目（S202010439048）

Survival factors of patients with hepatocellular carcinoma after radical hepatectomy

  • Online:2022-02-25 Published:2022-03-11

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摘要： 目的 探讨肝细胞癌（hepatocellular carcinoma，HCC）根治性切除术后总生存期（overall survival，OS）的影响因素。方法 回顾性收集于山东第一医科大学第二附属医院及山东大学第二医院行根治性切除术的1 744例HCC患者的临床资料，采用Cox回归分析影响OS的因素，利用R语言survminer软件包绘制森林图进行可视化展示。结果 1 744例HCC患者1、3、5年总生存率分别为73.5%、51.0%、22.2%。多因素Cox分析显示，男性（HR=1.242，P=0.026）、乙肝病毒 DNA≥500 copies/mL （HR=1.265，P<0.001）、甲胎蛋白≥400 ng/mL（HR=1.597，P<0.001）、中性粒细胞与淋巴细胞比值≥3.3（HR=1.288，P=0.003）、BCLC B/C期（HR=1.734，P<0.001）、微血管侵犯（HR=1.548，P<0.001）、肿瘤大小≥5 cm（HR=1.944，P<0.001）、多发病灶（HR=1.422，P<0.001）是影响HCC患者术后OS的独立危险因素，而肿瘤包膜完整（HR=0.673，P<0.001）和术后行肝动脉化疗栓塞（HR=0.652，P<0.001）是独立保护因素。结论 HCC患者术后总生存率较低是多因素共同作用的结果，其中乙肝病毒DNA≥500 copies/mL、甲胎蛋白≥400 ng/mL、中性粒细胞与淋巴细胞比值≥3.3、BCLC B/C期、微血管侵犯、肿瘤大小≥5 cm、多发病灶是独立危险因素，可作为术后治疗和预后评估指标。

关键词:  , 肝细胞癌；预后；影响因素；总生存期；根治性切除术

Abstract: Objective To investigate the factors influencing the overall survival (OS) of patients with hepatocellular carcinoma (HCC) after radical hepatectomy. Methods The clinical data of 1,744 HCC patients who underwent radical hepatectomy in Second Affiliated Hospital of Shandong First Medical University and the Second Hospital of Shandong University were retrospectively collected. The Cox regression proportional hazard model was used to analyze the factors influencing OS, and the survminer package (R language) was used to conduct the forest plots for visual display. Results The 1 -, 3- , and 5- year OS rates of 1,744 HCC patients were 73.5%, 51.0% and 22.2%, respectively. Multivariable Cox regression analysis showed that male (HR=1.242, P=0.026), hepatitis B virus DNA≥500 copies/mL (HR=1.265, P<0.001), alpha-fetoprotein≥400 ng/mL (HR=1.597,P<0.001), Neutrophil to lymphocyte ratio≥3.3 (HR=1.288, P=0.003), BCLC B/C stage (HR=1.734, P<0.001), microvascular invasion (HR=1.548, P<0.001), tumor size ≥5 cm (HR=1.944, P<0.001), and multinodular lesions (HR=1.422, P<0.001) were independent risk factors for OS of HCC patients, while complete tumor capsule (HR=0.673, P<0.001) and postoperative transcatheter arterial chemoembolization (HR=0.652, P<0.001) were independent protective factors. Conclusions The low postoperative OS of HCC patients is the result of multifactorial interaction, including hepatitis B virus DNA ≥500 copies/mL, alpha?fetoprotein ≥400 ng/mL, neutrophil to lymphocyte ratio ≥3.3, BCLC B/C stage, microvascular invasion, tumor size ≥5 cm, and multinodular lesions are independent risk factors and can be used as evaluation indicators for postoperative treatment and prognosis.

Key words: Hepatocellular carcinoma, Prognosis, Influencing factor, Overall survival, Radical hepatectomy

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