微血管侵犯对肝细胞癌根治性切除术后复发影响因素分析

摘要/Abstract

摘要： 目的评估微血管侵犯(MVI)对肝细胞癌(HCC)根治性切除术后复发的影响。方法回顾2014年1月至2018年12月行根治性切除术、经病理确诊的HCC患者104例。根据随访信息,将患者分为复发组、未复发组。多因素Logistic回归分析影响HCC患者复发与否的预测因素。结果 HCC患者复发组46例,非复发组58例。复发组、非复发组男性分别为40例(87.0%)、32例(55.2%),肿瘤直径>5 cm分别为27例(58.7%)、14例(24.1%),AFP>400 μg/L分别为16例(34.8%)、5例(8.6%),TBil>17 μmol/L分别为17例(37.0%)、10例(17.2%),MVI分别为29例(63.0%)、13例(22.4%),差异均有统计学意义(χ²=12.829、10.896、5.188、17.590,均P<0.05);而年龄、肝硬化、ALT>40 U/L、Alb>35 g/L、HBsAg及HBeAg等所占比例差异均无统计学意义(均P>0.05)。多因素 Logistic回归分析结果显示肿瘤直径>5 cm、AFP>400 μg/L及MVI是HCC患者复发的独立危险因素(P<0.05)。结论肿瘤直径、AFP水平及是否MVI 是影响HCC患者根治性切除术后复发的独立预测因素,可作为术后治疗的评估指标。

关键词: 肝细胞癌, 微血管侵犯, Logistic回归分析

Abstract: Objective To evaluate the effect of microvascular invasion (MVI) on recurrence of hepatocellular carcinoma (HCC) after radical resection.Methods There were 104 patients (72 males and 32 females) diagnosed with HCC by pathology after radical resection in our hospital from January 2014 to December 2018, with an average age of (52.3 ± 9.0) years. According to prognosis, the patients were divided into recurrence group and non-recurrence group. Univariate analysis was used to figure out factors with significant differences between the 2 groups, and multivariate logistic regression analysis was used to analyze the predictive factors of recurrence in HCC patients.Results There were 46 HCC patients in recurrence group and 58 in non-recurrence group. There were statistical differences in sex compositions, the incidence of > 5 cm tumor, the rates of alpha fetoprotein (AFP) > 400 μg/L and total bilirubin (TBil) > 17 mol/l, and the incidence of MVI between 2 groups (all P<0.05). Specifically, there were 40 (87.0%) and 32 (55.2%) cases of male (Z=12.166), 27 cases (58.7%) and 14 cases (24.1%) with tumor diameter > 5 cm (Z=12.829), 16 cases (34.8%) and 5 cases (8.6%) with AFP > 400 μg/L (Z=10.896), 17 cases (37.0%) and 10 cases (17.2%) with TBIL > 17 mol/L(Z=5.188), 29 cases (63.0%) and 13 cases (22.4%) of MVI (Z=17.590) in recurrence and non-recurrence groups, respectively. The age, liver cirrhosis, alanine aminotransferase > 40 U/L, albumin > 35 g/L, HBsAg and HBeAg were also significantly different between the 2 groups (P>0.05). The multivariate logistic regression model showed that tumor diameter > 5 cm, AFP > 400 μg/L and MVI were independent risk factors for recurrence of HCC.Conclusion Tumor diameter, AFP level and MVI are independent predictors for recurrence in HCC patients after radical resection, and can be used as evaluation indicators for postoperative treatment.

Key words: Hepatocellular carcinoma, Microvascular invasion, Logistic regression analysis

邸亮, 赵晓飞, 丁兢. 微血管侵犯对肝细胞癌根治性切除术后复发影响因素分析[J]. 肝脏, 2021, 26(6): 625-627.

DI Liang, ZHAO Xiao-fei, DING Jing. The effect of microvascular invasion on recurrence of hepatocellular carcinoma after radical resection[J]. Chinese Hepatolgy, 2021, 26(6): 625-627.

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