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目的研究肝癌患者血清HBeAg状态对肝癌切除术后复发及生存的影响。方法收集1999~2005年在我科行根治性切除的223例肿瘤直径≤3cm的肝癌患者的资料。根据患者术前血清HBeAg状态,分为HBeAg阳性组(n=73)和HBeAg阴性组(n=150),比较2组患者无瘤生存率(DFS)和总体生存率(OS),并分析影响DFS和OS的危险因素。结果HBeAg阳性和HBeAg阴性患者的1、3、5年的OS分别为91.5%、76.8%、60.1%和95.2%、85.3%、73.2%(P=0.053);1、3、5年DFS分别为73.3%、53.7%、40.3%和86.6%、65.5%、54.5%(P=0.002)。与HBeAg阴性组比较,HBeAg阳性组患者年龄较轻(P=0.004),肝硬变较重(P=0.008),而在肿瘤因素及手术相关因素方面2组间的差异无统计学意义(P>0.05)。对DFS和OS的多因素分析显示,年龄>50岁、HBeAg阳性和大结节肝硬变是影响OS的独立危险因素,而HBeAg阳性和多发肿瘤是影响DFS的独立危险因素。结论小肝癌患者术后HBeAg阳性患者较HBeAg阴性者更易早期复发,而且总体生存较差。
Objective To study the effect of serum HBeAg status on recurrence and survival of patients with liver cancer after resection of liver cancer. Methods The data of 223 patients with hepatocellular carcinoma whose diameter was less than 3cm were collected from our department during 1999-2005. The patients were divided into HBeAg positive group (n = 73) and HBeAg negative group (n = 150) according to the preoperative serum HBeAg status. The DFS and OS of the two groups were compared and analyzed DFS and OS risk factors. Results The OS of patients with HBeAg positive and HBeAg negative at 1, 3 and 5 years were 91.5%, 76.8%, 60.1% and 95.2%, 85.3% and 73.2% respectively (P = 0.053) 73.3%, 53.7%, 40.3% and 86.6%, 65.5% and 54.5% respectively (P = 0.002). Compared with HBeAg-negative group, patients in HBeAg-positive group were younger (P = 0.004) and cirrhosis was heavier (P = 0.008), while there was no significant difference in tumor and operation-related factors between the two groups > 0.05). Multivariate analysis of DFS and OS showed that HBeAg positive and large nodules cirrhosis were independent risk factors for OS. However, HBeAg positive and multiple tumors were independent risk factors for DFS. Conclusions The postoperative HBeAg positive patients with small HCC are more likely to relapse early and have worse overall survival than HBeAg negative patients.