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目的分析影响符合米兰标准的肝细胞肝癌肝切除术后预后的影响因素。方法回顾性分析2007~2013年期间267例于笔者所在医院行肝切除的肝细胞肝癌患者的资料。将患者的术前资料、肿瘤特征等予以单因素分析及多因素分析。结果 267例患者中有123例患者术后出现肿瘤复发,其复发时间2.7~75.1个月,均数为(16.9±14.5)个月;51例患者死亡,死亡时间6.1~75.4个月,均数为(27.5±16.4)个月。患者术后1、3及5年累积无瘤生存率分别为76.8%、56.3%和47.6%,累积生存率为96.6%、82.5%和74.5%。多因素分析显示,肿瘤分化程度、肿瘤微血管侵犯及多发肿瘤是肝癌切除术后肿瘤复发的独立危险因素,而肿瘤分化程度、术前HBVDNA阳性和术前中性粒细胞与淋巴细胞比值是影响患者生存的独立危险因素。结论肿瘤分化程度、肿瘤微血管侵犯和多发肿瘤影响符合米兰标准的肝细胞肝癌患者肝切除术后肿瘤复发,而肿瘤分化程度、术前HBV-DNA阳性和术前中性粒细胞与淋巴细胞比值影响患者的长期生存。
Objective To analyze the influencing factors that affect the prognosis of hepatocellular carcinoma after hepatectomy in line with the Milan criteria. Methods The data of 267 hepatocellular carcinoma patients who underwent hepatectomy at the author’s hospital from 2007 to 2013 were retrospectively analyzed. The patient’s preoperative data, tumor characteristics were univariate and multivariate analysis. Results Totally 123 out of 267 patients had tumor recurrence after operation. The recurrence time was 2.7-75.1 months (mean, 16.9 ± 14.5) months. 51 patients died and the death time was 6.1-75.4 months, with a mean of (27.5 ± 16.4) months. The cumulative tumor-free survival rates at 1, 3, and 5 years were 76.8%, 56.3% and 47.6% respectively, and the cumulative survival rates were 96.6%, 82.5% and 74.5% respectively. Multivariate analysis showed that the degree of tumor differentiation, tumor microvascular invasion and multiple tumors were independent risk factors for tumor recurrence after resection of liver cancer. The degree of tumor differentiation, preoperative HBVDNA positive and preoperative neutrophil to lymphocyte ratio were the risk factors Independent risk factors for survival. Conclusions The degree of tumor differentiation, tumor microvascular invasion and multiple tumor effects meet the Milan criteria for patients with hepatocellular carcinoma after liver resection tumor recurrence, and tumor differentiation, preoperative HBV-DNA positive and preoperative neutrophil and lymphocyte ratio Long-term patient survival.