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目的探讨直径大于8 cm单发肝细胞癌(肝癌)手术切除患者的生存影响因素。方法回顾性分析2009年1月至2011年12月在第二军医大学附属东方肝胆外科医院行手术切除的417例直径大于8 cm单发肝癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男374例,女43例;年龄17~83岁,中位年龄54岁。采用Kaplan-Meier法分析患者术后无瘤生存率及总生存率,Cox比例风险回归模型分析影响肿瘤复发和患者术后生存的因素。结果患者术后1、2、3、5年无瘤生存率和总生存率分别为46.1%、34.8%、27.5%、16.6%和62.8%、47.7%、41.1%、29.2%。术前HBV-DNA>200 k U/L、术前AFP>400μg/L、肝硬化、镜下子灶、微血管侵犯为影响肿瘤复发的独立危险因素(HR=1.421,1.527,1.368,1.481,1.386;P<0.05)。术前HBV-DNA>200 k U/L、术前AFP>400μg/L、术中出血量>400 ml、肝硬化、镜下子灶、微血管侵犯为影响患者术后生存的独立危险因素(HR=1.389,1.406,1.450,1.521,1.631,1.714;P<0.05)。结论术前HBV-DNA、术前AFP、术中出血量、肝硬化、镜下子灶、微血管侵犯为影响直径大于8 cm单发肝癌手术切除患者术后生存的独立影响因素。术前应积极行抗病毒治疗,术中减少出血,尽量根治性切除以降低复发率,改善患者术后生存。
Objective To investigate the influencing factors of survival in patients with single hepatocellular carcinoma (HCC) more than 8 cm in diameter. Methods The clinical data of 417 patients with hepatocellular carcinoma more than 8 cm in diameter who underwent surgical resection from January 2009 to December 2011 in the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University were retrospectively analyzed. All patients signed informed consent, in line with medical ethics rules. Including 374 males and 43 females; aged 17 to 83 years, with a median age of 54 years. The Kaplan-Meier method was used to analyze the postoperative tumor-free survival rate and overall survival rate. Cox proportional hazards regression model was used to analyze the factors influencing tumor recurrence and postoperative survival. Results The 1-year, 2-year, 3-year, 5-year disease-free survival and overall survival were 46.1%, 34.8%, 27.5%, 16.6% and 62.8%, 47.7%, 41.1% and 29.2%, respectively. Preoperative HBV-DNA> 200 kU / L, preoperative AFP> 400 μg / L, cirrhosis, microscopic lesions and microvascular invasion were independent risk factors for tumor recurrence (HR = 1.421,1.527,1.368,1.481,1.386; P <0.05). Preoperative HBV-DNA> 200 kU / L, preoperative AFP> 400 μg / L, intraoperative blood loss> 400 ml, liver cirrhosis, microscopic lesions and microvascular invasion were independent risk factors for postoperative survival (HR = 1.389, 1.406, 1.450, 1.521, 1.631, 1.714; P <0.05). Conclusion Preoperative HBV-DNA, preoperative AFP, intraoperative blood loss, liver cirrhosis, microscopic lesion and microvascular invasion are the independent influencing factors of postoperative survival in patients with single hepatocellular carcinoma more than 8 cm in diameter. Preoperative antiviral therapy should be active, reduce bleeding during surgery, radical resection as possible to reduce the recurrence rate and improve postoperative survival.