吲哚菁绿引导下腹腔镜肝部分切除术后癌症复发的影响因素分析

摘要/Abstract

摘要： 目的分析吲哚菁绿引导下腹腔镜肝部分切除术后癌症复发的影响因素。方法回顾性分析2021年1月至2022年12月期间江苏省人民医院宿迁医院收治的97例吲哚菁绿引导下腹腔镜肝部分切除术患者的临床资料,所有患者均随访至2024年10月。统计患者的癌症复发情况(根据复发情况分为复发组和未复发组)及复发患者的无复发生存期(RFS),分析肝细胞癌患者吲哚菁绿引导下腹腔镜肝部分切除术后癌症复发的影响因素。结果 97例患者中,3例失访,故本研究中统计的总例数为94例,包括36例癌症复发患者和58例未复发患者。36例癌症复发患者的平均无复发生存期为28.00个月(95％CI:25.391~30.609)。复发组的血清AFP水平[(164.85±34.28)ng/mL]、肿瘤数量2～3个占比(69.44%)、低分化率(55.56%)及微血管浸润率(69.44%),均高于未复发组[(94.69±16.27)ng/mL、29.31%、27.59%、46.55%];肿瘤直径(7.52±1.35)cm大于未复发组[(5.31±1.06)cm](P<0.05)。多因素logistic回归分析得出:AFP高水平[OR:1.152(95%CI:1.082~1.228)]、肿瘤大[OR:5.046(95%CI:2.672~9.527)]、肿瘤数量多[OR:5.481(95%CI:2.213~13.576)]、分化程度低[OR:3.281(95%CI:1.369~7.863)]、存在微血管浸润[OR:2.609(95%CI:1.086~6.272)]为吲哚菁绿引导下腹腔镜肝部分切除术患者癌症复发的危险因素(P<0.05)。ROC曲线得出:以上五项联合预测患者癌症复发的AUC值为0.973,具有较高的预测价值。结论高AFP水平、肿瘤大、肿瘤数量多、分化程度低、存在微血管浸润均为吲哚菁绿引导下腹腔镜肝部分切除术患者癌症复发的独立危险因素,五项联合可更好地预测患者的癌症复发情况,辅助医生制定个性化的术后管理方案。

关键词: 吲哚菁绿, 腹腔镜, 肝部分切除术, 癌症, 复发, 影响因素

Abstract: Objective To analyze the influencing factors of cancer recurrence after indocyanine green guided laparoscopic partial hepatectomy. Methods The clinical data of 97 patients with indocyanine green-guided laparoscopic partial hepatectomy admitted to Suqian Hospital of Jiangsu Provincial People′s Hospital from January 2021 to December 2022 were retrospectively analyzed. All patients were followed up until October 2024, and were divided into recurrence group and non-recurrence group according to the recurrence of cancer. The cancer recurrence and relapse-free survival (RFS) of the patients were statistically analyzed. The influencing factors of cancer recurrence in patients with hepatocellular carcinoma (HCC) after indocyanine green guided laparoscopic partial hepatectomy, and the value of significant factors in predicting cancer recurrence in patients with HCC were further explored. Results Among 97 patients, 3 cases were lost ,so the total number of cases in this study was 94, including 36 patients with cancer recurrence and 58 patients without cancer recurrence. The mean RFS of 36 patients with recurrent cancer was 28.00 months (95%CI: 25.391 ~ 30.609). The serum AFP level (164.85±34.28) ng/mL, the rate of tumor number 2~3 (69.44%), low differentiation rate (55.56%) and microvascular infiltration rate (69.44%) in the relapsed group were higher than those in the non-relapsed group [(94.69±16.27) ng/mL, (29.31%), (27.59%), (46.55%)], the tumor diameter [(7.52±1.35) cm] was higher than that of the non-recurrence group [(5.31±1.06)cm] (P<0.05). Multivariate logistic regression analysis showed that high AFP levels [OR:1.152 (95%CI: 1.082 ~ 1.228)], large tumors [OR:5.046 (95%CI:2.672 ~ 9.527)], and numerous tumor [OR:5.481 (95%CI:2.213 ~ 13.576)], low differentiation degree [OR:3.281 (95%CI:1.369~7.863)], microvascular infiltration [OR:2.609 (95%CI:1.086~6.272)] were the risk factors for cancer recurrence in indocyanine green-guided laparoscopic partial hepatectomy (P<0.05). The ROC curve showed that the AUC value of the combination of these five factors to predict cancer recurrence was 0.973, which had high predictive value. Conclusion High AFP level, large and numerous tumors,low differentiation degree,and microvascular infiltration are all independent risk factors for cancer recurrence in patients undergoing indocyanine green-guided laparoscopic partial hepatectomy. The combination of the five factors can better predict cancer recurrence in patients and assist doctors to develop personalized postoperative management plans.

Key words: Indocyanine green, Laparoscopy, Partial hepatectomy, Cancer, Recurrence, Influencing factor

陈晨, 朱恽, 李永波, 汪蕾. 吲哚菁绿引导下腹腔镜肝部分切除术后癌症复发的影响因素分析[J]. 肝脏, 2026, 31(3): 380-384.

CHEN Chen, ZHU Yun, LI Yong-bo, WANG Lei. Analysis of influencing factors of cancer recurrence after indocyanine green guided laparoscopic partial hepatectomy[J]. Chinese Hepatolgy, 2026, 31(3): 380-384.

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