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1、·328·2014年5月第2O卷第5期ChinJHepatobiliarySurg，May2014，Vo1．20,No．5·論著·巨大肝癌外科治療的預(yù)后影響因素吳凡王黎明吳健雄劉立國榮維淇余微波安松林劉發(fā)強馮莉田斐【摘要】目的分析外科治療巨大肝癌的預(yù)后相關(guān)因素，提高其綜合治療水平。方法回顧性分析51例經(jīng)外科治療的巨大肝癌患者的臨床資料。應(yīng)用Kapla—Meier方法計算生存時間，Cox回歸法對15個可能與預(yù)后相關(guān)的臨床病理因素進行統(tǒng)計學(xué)分析。結(jié)果50例患者獲得隨訪。術(shù)后1、3、5年生存率分別為75．8％、37．9％和21．1％。單因素分析顯示術(shù)前AFP大于400
2、L、腫瘤大于12em、腫瘤邊界是否清楚、有無血管侵犯、TNM分期與巨大肝癌的預(yù)后有關(guān)；Cox多因素回歸分析結(jié)果顯示，有無血管侵犯、腫瘤邊界是否清楚、腫瘤大于12cm是影響巨大肝癌預(yù)后的獨立因素。單因素分析顯示腫瘤邊界是否清楚、有無血管侵犯、TNM分期是影響患者復(fù)發(fā)的重要因素；Cox多因素分析顯示血管侵犯是影響患者復(fù)發(fā)的獨立因素。結(jié)論外科治療巨大肝癌相對安全可靠，可改善患者預(yù)后。對高危因素患者需要依靠綜合治療以延長生存期?！娟P(guān)鍵詞】肝癌；肝切除術(shù)；預(yù)后Prognosticfactorsforpatientswhounderwentsurgicaltreatment
3、forhugelivercancerWuFan，WangLiming，WuJianxiong，LiuLiguo，RongWeiqi，YuWeibo，AnSonglin，LiuFaqiang，Li，TianFei．DepartmentofHepatobiliarySurgery，CancerHospital，ChineseAcademyofMedicalSciencesandPekingUnionMedicalCollege，Beijing100021，ChinaCorrespondingauthor：WuJianxiong，EmaiZ：dr．@hotmail．c
4、om【Abstract】ObjectiveToanalyzetheprognosticfactorsforpatientswhounderwentsurgicalresec—tionforhugelivercancerSOastoimprovethemedicalresultsofcomprehensivetherapy．MethodsWeret—rospectivelyanlaysedthedataof51patientswhounderwentsurgicalresectionforhugelivercancer．Fifteenclinicopatholog
5、icfactorspossiblyinfluencingsurvivalwereselected，andmultivariateanalysisoftheseparam—eterswasperformedusingtheCoxproportionalhazardsmode1．SurvivalanalysiswasdoneusingtheKaplan—Meiermethod．ResultsTheoverall1一，3一，5-yearsurvivalratesof50patientswere75．8％，37．9％and21．1％，respectively．Univa
6、riateanalysisshowedthatAFPover400g／L，tumordiameterover12cm，tumorboundary，vascularinvasionandTNMstagingsignificantlyaffectedpostoperativesurviva1．Coxmuhi—variateanalysisindicatedthattumordiameterof≥12cm．tumorboundaryandvascularinvasionwereinde·pendentprognosticfactors．Univariateanalys
7、isshowedthattumorboundary，vascularinvasionandTNMstagingweretheindependentfactorsafectingrecurrence，Coxmultivariateanalysisshowedthatvascularin—vasionwasanindependentfactorinfluencingrecurenceoftumor．ConclusionsSurgicalresectionforpa—tientswithhugelivercancercouldbesafelyperformedwith
8、reasonablelo
