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目的明确肝切除术后肝癌患者远期预后的影响因素,探讨术前血浆前白蛋白(PA)含量在评估肝癌患者肝切除术后远期预后中的价值。方法回顾性分析第二军医大学东方肝胆外科医院2011年12月—2012年3月期间施行肝切除术的原发性肝癌患者病例资料及随访资料,用单因素及多因素Cox回归分析法分析术前多项指标对患者总生存时间及术后复发的影响。根据术前血浆PA含量的临界值,分为低PA组(术前PA含量≤152mg/L)和高PA组(术前PA含量>152mg/L),用Kaplan-Meier法分析两组间预后的差异。结果共373例行肝切除术的肝癌患者纳入本研究,中位生存时间32.3个月,中位肿瘤复发时间20.5个月。肿瘤大小(P=0.003)、TNM分期(P<0.001)、术前血浆PA含量(P=0.034)、血管侵犯(P=0.027)是影响患者术后总生存时间的独立危险因素,TNM分期(P<0.000 1)、术前血浆PA含量(P=0.002)、血管侵犯(P=0.048)是影响患者术后复发的独立危险因素。高PA组中位生存时间和中位复发时间分别为41.3个月和28.8个月,优于低PA组的31.7个月和14.4个月,两组间差异有统计学意义(P<0.000 1)。结论术前血浆PA含量低是肝癌患者行肝切除术后总生存期和肿瘤复发的独立危险因素。
Objective To investigate the influencing factors of long-term prognosis of patients with liver cancer after hepatectomy and to evaluate the value of preoperative plasma albumin (PA) in assessing long-term prognosis of patients with liver cancer after hepatectomy. Methods The clinical data and follow-up data of patients with primary liver cancer undergoing hepatectomy from December 2011 to March 2012 at Oriental Hepatobiliary Surgery Hospital of the Second Military Medical University were retrospectively analyzed. Univariate and multivariate Cox regression analysis The influence of multiple indexes before and after surgery on the total survival time and postoperative recurrence. According to the preoperative plasma PA level, the patients were divided into low PA group (preoperative PA content ≤152mg / L) and high PA group (preoperative PA content> 152mg / L). The Kaplan-Meier method was used to analyze the prognosis The difference. Results A total of 373 patients with liver cancer undergoing hepatectomy were enrolled in this study. The median survival time was 32.3 months and the median tumor recurrence time was 20.5 months. The tumor size (P = 0.003), TNM stage (P <0.001), preoperative plasma PA level (P = 0.034) and vascular invasion (P = 0.027) were the independent risk factors for the total postoperative survival time. P <0.000 1). Preoperative plasma PA level (P = 0.002) and vascular invasion (P = 0.048) were independent risk factors for postoperative recurrence. The median survival time and median time to recurrence in high PA group were 41.3 months and 28.8 months respectively, which were significantly better than those in low PA group (31.7 months and 14.4 months, respectively) (P <0.000 1) . Conclusions Preoperative low plasma PA level is an independent risk factor for overall survival and tumor recurrence after liver resection in patients with liver cancer.