| 摘要: |
| 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≤152 mg/L）和高PA组（术前PA含量>152 mg/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。 |
| 关键词: 肝肿瘤 肝细胞癌 肝切除术 前白蛋白 肿瘤复发 生存时间 |
| DOI：10.16781/j.0258-879x.2017.04.0463 |
| 投稿时间：2017-02-20修订日期：2017-03-11 |
| 基金项目: |
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| Value of preoperative prealbumin content in assessing long-term prognosis of patients with hepatocellular carcinoma after hepatectomy |
| ZHAO Xi-jun1,JIN Guang-zhi2,YANG Ning1,DONG Wei2,YANG Guang-shun1* |
(1. Department of Hepatic Surgery(Ⅴ), Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China;
2. Department of Pathology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
*Corresponding author) |
| Abstract: |
| Objective To clarify the factors influencing long-term prognosis of patients with hepatocellular carcinoma (HCC) after hepatectomy, and to explore the value of preoperative plasma prealbumin (PA) in assessing the long-term prognosis. Methods We retrospectively analyzed the clinical and follow-up data of HCC patients who underwent hepatectomy in Eastern Hepatobiliary Surgery Hospital between Dec. 2011 and Mar. 2012. Univariate and multivariate Cox regression analyses were used to analyze the effects of preoperative factors on the overall survival time and recurrence of patients. According to the content of preoperative plasma PA, the patients were divided into high PA group (preoperative PA content was higher than 152 mg/L) and low PA group (preoperative PA content was lower than 152 mg/L); then the difference of prognosis between the two groups were compared by Kaplan-Meier methods. Results A total of 373 HCC patients undergoing hepatectomy were included in this study. The median survival time was 32.3 months and the median recurrence time was 20.5 months. Univariate and multivariate analysis showed that tumor size (P=0.003), TNM stage (P<0.001), preoperative PA content (P=0.034), and vascular invasion (P=0.027) were the independent risk factors for long-term overall survival time of patients after hepatectomy; while TNM stage (P<0.000 1), preoperative PA content (P=0.002), and vascular invasion (P=0.048) were the independent risk factors for recurrence of patients after hepatectomy. The median overall survival time and median recurrence time of patients in the high PA group were both significantly longer than those in the low PA group, respectively (median overall survival time: 41.3 months vs 31.7 months, P<0.000 1; median recurrence time: 28.8 months vs 14.4 months, P<0.000 1). Conclusion Low preoperative PA content is an independent risk factor for long-term overall survival and recurrence of HCC patients after hepatectomy. |
| Key words: liver neoplasms hepatocellular carcinoma hepatectomy prealbumin neoplasm recurrence overall survival |
