原发性肝癌根治术后3年生存率与BCLC Kinki分期的关系

摘要/Abstract

摘要： 目的探讨原发性肝癌(HCC)根治术后3年生存率与巴塞罗那临床肝癌(BCLC)Kinki分期的关系。方法回顾性分析2016年4月至2018年4月99例接受开放性肝癌切除术HCC患者的临床资料,依据患者术后3年生存情况分为存活组(n=64)与死亡组(n=35)。对比两组基线资料信息(性别、年龄、居住地区、民族、肿瘤直径、肿瘤个数、肿瘤部位、肝炎病史、家族史、Child Pugh分级、TNM分期、分化程度、BCLC Kinki分期),多因素logistic回归分析影响HCC患者根治手术预后的危险因素。比较不同BCLC Kinki分期HCC患者3年生存率。结果死亡组患者肿瘤直径＞5 cm 30例(85.71%)、肿瘤直径≤5 cm 5例(14.29%),存活组患者肿瘤直径＞5 cm 38例(59.38%)、肿瘤直径≤5 cm 26例(40.63%),差异有统计学意义(χ²=18.723,P<0.05);死亡组Child Pugh A级13例(37.14%)、Child Pugh B级22例(62.86%),存活组Child Pugh A级40例(62.50%)、Child Pugh B级24例(37.50%),差异有统计学意义(χ²=5.849,P<0.05);死亡组TNM分期Ⅰ或Ⅱ期10例(28.57%)、TNM分期Ⅲ或Ⅳ期25例(71.43%),存活组TNM分期Ⅰ或Ⅱ期38例(59.38%),TNM分期Ⅲ或Ⅳ期26例(40.62%),差异有统计学意义(χ²=8.597,P<0.05);死亡组分化程度低分化24例(68.57%)、分化程度中-高分化11例(31.43%),存活组分化程度低分化14例(21.88%)、分化程度中-高分化50例(78.12%),差异有统计学意义(χ²=20.861,P<0.05);死亡组BCLC Kinki分期B1期9例(25.71%)、BCLC Kinki分期B2期26例(74.29%),存活组BCLC Kinki分期B1期39例(60.94%)、BCLC Kinki分期B2期25例(39.06%),差异有统计学意义(χ²=11.239,P<0.05)。经多因素logistic回归分析证实,肿瘤直径＞5 cm、Child Pugh分级为B级、TNM分期为Ⅲ或Ⅳ期、分化程度为低分化、BCLC Kinki分期为B2期是影响HCC患者根治手术预后的危险因素。结论 HCC患者根治手术后的生存率受到肿瘤直径、Child Pugh分级、TNM分期、分化程度、BCLC Kinki分期的影响,其中BCLC Kinki分期B1期患者生存率较高,BCLC Kinki分期B2期患者生存率较低。

关键词: 原发性肝癌, Kinki分期, 根治术, 预后, 危险因素, 生存率

Abstract: Objective To investigate the relationship between 3-year survival rate after radical resection and Barcelona Clinic Liver Cancer (BCLC) Kinki stage.in patients with primary liver cancer (PLC). Methods The clinical data of 99 PLC patients underwent open liver resection from April 2016 to April 2018 were retrospectively analyzed. The patients were divided into good prognosis group (n = 64, survival) and poor prognosis group (n = 35, death) according to their 3-year survival condition. The baseline data of the 2 groups including gender, age, residence, ethnicity, tumor diameter, tumor number, tumor site, hepatitis history, family history, Child-Pugh grade, TNM stage, differentiation degree, and BCLC Kinki stage were collected and analyzed. The differences between the 2 groups were analyzed by multivariate logistic regression analysis and the risk factors affecting the prognosis were determined. The patients were followed up for 3 years, and the 3-year survival rates among the paients with different BCLC Kinki stage were compared. Results In poor prognosis group, the number of patients with tumor diameter > 5cm was 30 (85.71%), and the number of patients with tumor diameter ≤ 5 cm was 5 (14.29%). In good prognosis group, the number of patients with tumor diameter > 5 cm was 38 (59.38%), and the number of patients with tumor diameter ≤ 5 cm was 26 (40.63%). The difference was statistically significant (χ²=18.723, P<0.05). There were 13 Child-Pugh grade A cases (37.14%) and 22 Child-Pugh grade B cases (62.86%) in poor prognosis group. There were 40 Child-Pugh grade A cases (62.50%) and 24 Child-Pugh grade B cases (37.50%) in good prognosis group. The difference was statistically significant (χ²=5.849, P<0.05). In poor prognosis group, there were 10 TNM stage I or II cases (28.57%) and 25 TNM stage III or IV cases (71.43%). In good prognosis group, there were 38 TNM stage I or II cases (59.38%) and 26 TNM stage III or IV cases (40.62%), the difference was statistically significant (χ²=8.597, P<0.05). In poor prognosis group, there were 24 cases with poorly differentiated tumors (68.57%) and 11 cases with moderately or highly differentiated (31.43%), while in good prognosis group, there were 14 cases with poorly differentiated tumors (21.88%) and 50 cases with moderately or highly differentiated (78.12%), the difference was statistically significant (χ²=20.861, P<0.05). In poor prognosis group, there were 9 cases in BCLC Kinki B1 stage (25.71%) and 26 cases in BCLC Kinki B2 stage (74.29%). In good prognosis group, there were 39 cases in BCLC Kinki B1 stage (60.94%) and 25 cases in BCLC Kinki B2 stage (39.06%). The difference was statistically significant (χ²=11.239, P<0.05). Multivariate Logistic regression analysis confirmed that tumor diameter > 5 cm, Child-Pugh grade B, TNM stage Ⅲ or IV stage, low differentiation degree, BCLC Kinki B2 stage were risk factors affecting the prognosis of patients with PLC after radical resection, all with P<0.05. The 3-year survival rates of BCLC Kinki stage B1 and stage B2 patients were 60.94% and 39.06%, respectively, and the 3-year survival rates of patients with different BCLC Kinki stage were significantly different (P<0.05). Conclusion The survival rates of patients with PLC after radical resection are affected by tumor diameter, Child-Pugh grade, TNM stage, differentiation degree, and BCLC Kinki stage. Compared to BCLC Kinki stage B2 patients, the survival rates of BCLC Kinki stage B1 patients are higher.

Key words: Primary liver cancer, Kinki stage, Radical resection, Prognosis, Risk factor, Survival rate

陈兴阳, 陈英杰, 陈雷, 张盛. 原发性肝癌根治术后3年生存率与BCLC Kinki分期的关系[J]. 肝脏, 2021, 26(12): 1324-1327.

CHEN Xing-yang, CHEN Ying-jie, CHEN Lei, ZHANG Sheng. Relationship between 3-year survival rates after radical resection and BCLC Kinki stage in patients with primary liver cancer[J]. Chinese Hepatolgy, 2021, 26(12): 1324-1327.

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