摘要目的 探讨影响孤立性大肝癌患者肝切除术后长期生存的预后因素.方法 回顾性分析2004年1月至2012年12月中南大学湘雅医院外科连续收治的接受肝切除术治疗的215例孤立性大肝癌患者的临床资料.男性182例,女性33例,年龄24 ～ 69岁,中位年龄46岁.采用Kaplan-Meier法和Log-rank检验分析年龄、性别、肝硬化、慢性病毒性肝炎、Child-Pugh评分、微血管侵犯、大体血管侵犯和TNM分期等临床病理因素对孤立性大肝癌患者肝切除术后总体生存率和无瘤生存率的影响.通过单因素和多因素分析影响孤立性大肝癌术后长期生存的预后因素.结果 本组孤立性大肝癌患者的1、3、5年总体生存率分别为88.1％、60.2％、41.7％,1、3、5年无瘤生存率分别为80.1％、49.4％、33.6％.有微血管侵犯的孤立性大肝癌患者的1、3、5年总体生存率和无瘤生存率分别为82.0％、45.1％、29.0％和69.6％、36.1％、23.5％;有大体血管侵犯的孤立性大肝癌患者的1、3、5年总体生存率和无瘤生存率分别为64.7％、34.3％、18.3％和54.2％、24.1％、0;无血管侵犯的孤立性大肝癌患者的1、3、5年总体生存率和无瘤生存率分别为95.0％、72.3％、51.8％和90.1％、60.9％、42.9％.单因素分析结果显示,肝硬化、微血管侵犯、大体血管侵犯、TNM分期是影响孤立性大肝癌患者肝切除术后总体生存率的预后因素(x2=4.953、8.835、15.237、19.789,P值均＜0.05);微血管侵犯、大体血管侵犯、TNM分期则是影响孤立性大肝癌患者肝切除术后无瘤生存率的预后因素(x2=12.974、13.247、24.516,P值均＜0.05).多因素Cox回归分析结果表明,微血管侵犯、大体血管侵犯、TNM分期是影响孤立性大肝癌患者肝切除术后总体生存率和无瘤生存率的独立预后因素(P值均＜0.05).结论 微血管侵犯、大体血管侵犯和TNM分期是孤立性大肝癌患者肝切除术后长期生存的独立预后因素.

abstractsObjective To explore the prognostic factors that have affected the long-term survival of solitary large hepatocellular carcinoma (SLHCC) patients after hepatectomy.Methods The clinical data of 215 SLHCC patients accepted hepatectomy in the Xiangya Hospital,Central South University from January 2004 to December 2012 were retrospectively analyzed.There were 182 males and 33 females aged from 24 to 69 years(median age was 46 years).Using a variety of statistical methods,including the Kaplan-Meier estimator and the Log-rank test,the impacts of an array of clinicopathologic factors,such as age,gender,liver cirrhosis,chronic viral hepatitis,the Child-Pugh grading,microvascular invasion,macrovascular invasion and TNM staging,on the overall survival and the disease-free survival of SLHCC patients after hepatectomy were analyzed.The prognostic factors were evaluated by univariate and multivariate analyses for the long-term survival of SLHCC patients after hepatectomy.Results The whole group of patients with SLHCC showed 1-,3-,and 5-year overall survival rates of 88.1％,60.2％,and 41.7％,respectively,and exhibited 1-,3-,and 5-year disease-free survival rates of 80.1％,49.4％,and 33.6％,respectively.The 1-,3-,and 5-year overall survival rates and disease-free survival rates of SLHCC patients with microvascular invasion were 82.0％,45.1％,29.0％ and 69.6％,36.1％,23.5％,respectively.In addition,the 1-,3-,and 5-year overall survival rates and disease-free survival rates of SLHCC patients with macrovascular invasion were 64.7％,34.3％,18.3％ and 54.2％,24.1％,0,respectively.In contrast,the 1-,3-,and 5-year overall survival rates and disease-free survival rates of SLHCC patients without vascular invasion were 95.0％,72.3％,51.8％ and 90.1％,60.9％,42.9％,respectively.The results of univariate analysis indicated that liver cirrhosis,microvascular invasion,macrovascular invasion,TNM staging were hazardous factors for the overall survival of SLHCC patients (x2 =4.953,8.835,15.237,19.789 respectively,all P ＜0.05) ; while microvascular invasion,macrovascular invasion,TNM staging were risk factors for the diseasefree survival of SLHCC patients (x2 =12.974,13.247,24.516 respectively,all P ＜ 0.05).Furthermore,the multivariate analysis suggested that microvascular invasion,macrovascular invasion,TNM staging were the independent prognostic factors that have affected the overall survival and disease-free survival of SLHCC patients(all P ＜ 0.05).Conclusion Microvascular invasion,macrovascular invasion and TNM staging were the independent prognostic factors for the long-term survival of patients with SLHCC after hepatectomy.