摘要目的 分析肝细胞癌(HCC)患者肝切除术后早期复发的影响因素.方法 回顾分析2009年1月至2012年12月复旦大学附属中山医院行肝部分切除术的178例HCC患者资料,男性151例,女性27例,年龄(58±11)岁.分析患者CT图像,评估环形强化、卫星灶、病灶内出现供血小动脉不伴有周边低密度环(TTPVI)、肿瘤边缘不规则等征象.所有患者出院后均规律随访,终点事件为术后2年内肝内复发,如未复发,则至少随访2年.结果 单因素分析筛选出AFP≥200 μg/L、肿瘤最大径＞5 cm、环形强化、TTPvI以及肿瘤边缘不规则为HCC患者肝切除术后复发的影响因素.将上述因素纳入多因素Cox回归分析,AFP≥200 μg/L(HR=2.144,95％CI:1.350～ 3.406)、环形强化(HR=2.196,95％CI:1.345～3.587)、TTPVI(HR=1.735,95％ CI:1.086 ～ 2.772)及肿瘤边缘不规则(HR=2.065,95％ CI:1.242～ 3.432)为HCC患者肝切除术后早期复发的危险因素.结论 AFP≥200 μg/L及CT征象(环形强化、肿瘤边缘不规则、TTPVI)是HCC患者术后早期复发的独立危险因素.

abstractsObjective To identify the risk factors of early post-surgical recurrence of hepatocellular carcinoma (HCC) within 2 years.Methods This retrospective study included 178 consecutive patients with HCC who underwent curative resection between January 2009 to December 2012 at Zhongshan Hospital,Fudan University.There were 151 males and 27 females,with a mean age of (58±11) years.The CT features including rim enhancement,satellite nodule,two-trait predictor of venous invasion (TTPVI),and nonsmooth tumor margins were reviewed.After hospital discharge,the patients were followed-up regularly for at least 2 years to detect tumor recurrence.The primary end point was recurrence of HCC.Results On univariate analyses AFP ≥ 200 μg/L,rim enhancement,TTPVI,non-smooth tumor margins and largest diameter ＞5 cm were correlated with early post-surgical recurrence of HCC.On multivariate analyses,AFP≥200 pg/L (HR=2.144,95％CI:1.350～ 3.406),rim enhancement (HR =2.196,95％ CI:1.345 ～ 3.587),TTPVI (HR=1.735,95％CI:1.086～2.772),and non-smooth tumor margins (HR=2.065,95％CI:1.242～3.432) were independent risk factors of early post-surgical recurrence of HCC.Conclusion AFP≥200 μg/L,rim enhancement,TTPVI,and non-smooth tumor margins were independent risk factors of early post-surgical recurrence of HCC.