摘要目的 用Cox模型多因素分析再手术切除治疗复发性肝癌的疗效,探讨其预后影响因素.方法 1995年1月-2010年12月收集60例复发性肝癌行再手术切除的患者资料,分析其疗效并收集17项可能影响预后的临床及病理因素作回顾性单因素(Kaplan-Meier Log-rank test)与多因素分析(Cox模型),得出其生存预后影响因素.结果 全组患者1、3、5年生存率分别是76.3%、40.7%、25.0%(从再切除术后算起)和95.0%、62.6%、43.3%(从初次手术算起);单因素分析显示初次肿瘤大小、复发期限长短、血清ALB水平、手术切缘、复发肿瘤最大径、血管侵犯与复发性肝癌再手术切除预后差异有统计学意义(P<0.05);进一步行Cox模型多因素分析得出与预后有关因素为:复发期限长短、手术切缘、复发肿瘤最大径与血管侵犯(P<0.05).结论 再手术切除治疗复发性肝癌疗效确切,复发期限长短、手术切缘、复发肿瘤最大径与血管侵犯为其显著性预后影响因子.

abstractsObjective This retrospective study was to explore the efficacy and determine the risk factors of survival for recurrent hepatocellular carcinoma ( HCC) treated by repeat hepatectomy. Methods From January 1995 till December 2010, 60 patients with recurrent HCCs, were treated by repeat hepatectomy.The significance of seventeen clinical or pathological variables in the risk factors of overall survival were assessed. Results The overall survival 1,3, and 5-year survival rates were 76. 3% , 40.7% and 25. 0% (from repeat hepatectomy), and 95. 0% , 62. 6% and 43. 3% ( from initial hepatectomy) , respectively.Univariate analysis indicated that tumor size at initial hepatectomy, recurrence interval from initial hepatectomy, serum albumin(ALB) level, resection margin, diameter of largest recurrence tumor and rumor vascular invasion were significant prognostic factors(P <0. 05, Kaplan-Meier Log-rank test). Multivariate analysis showed recurrence interval from initial hepatectomy, resection margin, diameter of largest recurrence tumor and rumor vascular invasion were significant prognostic factors(P<0.05, Cox proportional hazards model).Conclusion Repeat hepatectomy is effective for recurrent HCC. Recurrence interval from initial hepatectomy, resection margin, diameter of largest recurrence tumor and rumor vascular invasion were significant prognostic factors.