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肝细胞癌患者根治性切除术后的预后因素分析

Analysis of prognostic factors of patients with hepatocellular carcinoma after radical resection

摘要:

目的 探讨接受根治性切除术的肝细胞癌(HCC)患者的预后影响因素.方法 收集2006年6月至2009年11月在重庆医科大学附属第一医院肝胆外科接受根治性切除手术的208例HCC患者的临床资料,其中男性173例,女性35例,中位年龄53岁.所有患者出院后均以电话、短信、门诊方式随访.通过Kaplan-Meier进行预后影响因素的单因素分析,将有统计学意义的指标进一步纳入Cox比例风险回归模型进行多因素分析.根据术前外周血中单核细胞和淋巴细胞比例(MLR)将患者分为低MLR组(MLR≤1.2)和高MLR组(MLR> 1.2).结果 208例患者中位生存时间为38个月(1.5 ~82.2个月),中位无瘤生存时间为36个月(1.0 ~82.0个月).单因素分析结果表明,AST、清蛋白、癌栓、肿瘤分级、肿瘤最大径、TNM分期、BCLC分期和MLR是HCC患者的预后影响因素(P值均<0.05).多因素分析结果表明,TNM分期和MLR均是影响HCC患者根治性切除术后总体生存时间和无瘤生存时间的独立预后因素(P值均< 0.05).低MLR组患者总生存时间(42.1个月)和无瘤生存时间(38.1个月)均优于高MLR组(32.7个月和25.3个月)(D值均<0.01).结论 MLR水平可能与HCC根治性切除术预后呈显著负相关,MLR、TNM分期可能是HCC根治性切除术后的独立预后因素.

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abstracts:

Objective To explore the prognostic factors of patients with hepatocellular carcinoma(HCC) after radical resection.Methods From June 2006 to November 2009,preoperative peripheral blood and the clinicopathological data of 208 patients with HCC after curative resection treated in Department of Hepatobiliary Surgery,the First Affiliated Hospital of Chongqing Medical University,were collected and analyzed,including 173 male and 35 female patients with mean age of 53 years.Univariate analyses were applied by the Kaplan-Meier method,and then,significant clinical factors were used for further multivariate analyses by Cox proportional hazard regression model.The patients were divided into low-lymphocyte-monocyte ratio (MLR) group (MLR ≤ 1.2) and high-MLR group (MLR > 1.2) according to preoperative MLR.Results The enrolled 208 patients with median overall survival time for 38 months (1.5-82.2 months),median recurrence-free survival time for 36 months(1.0-82.0 months).Univariate analyses revealed alanine aminotransferase,serum albumin,tumor differentiation,tumor size,TNM stage and clinical stages and MLR might affect the prognosis significantly (all P < 0.05),and multiple analyses showed that TNM stage and MLR could influence patients with HCC after radical resection of overall survival time and recurrence-free survival time(all P < 0.05).The overall survival time(42.1 months) and recurrence-free survival time (38.1 months) of low-MLR group were longer than high-MLR group (32.7 months and25.3 months) (both P < 0.01).Conclusions MLR might be associated with prognosis of patients with HCC after curative resection was significantly negative correlation.TNM stage and MLR might be used as an independent prognostic factors for the prognosis of patients with HCC after curative resection.

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作者: 唐涛 [1] 廖锐 [1] 李静 [1] 杜成友 [1]
第一作者: 唐涛
期刊: 《中华外科杂志》2016年54卷6期 439-443页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2016.06.010
发布时间: 2016-07-05
基金项目:
国家临床重点专科建设资助项目 国家自然科学基金资助项目 National Key Specialty Construction of Clinical Projects ( National Natural Science Foundation of China
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