摘要目的 评估术前血清γ-谷氨酰转肽酶(gamma glutamyl transpeptidase,GGT)的水平在预测肝细胞癌(hepatocellular carcinoma,HCC)患者肝切除术后预后的价值.方法 回顾性收集432例HCC根治性切除术后患者的临床病理资料,并将患者分为正常GGT组(术前GGT≤50 U/L,175例)和高GGT组(术前GGT＞ 50 U/L,257例).利用倾向性分析均衡两组的基线资料后,比较两组患者的无瘤生存率和总生存率,并用Cox回归分析影响HCC术后无瘤生存率和总生存率的风险因素.结果 经过倾向性分析,共有124对患者匹配成功,组间各基线资料均衡.正常GGT组和高GGT组患者术后1、3、5年的无瘤生存率分别为69.3％、36.1％、12.8％和60.6％、18.7％、7.5％(P=0.039).正常GGT组和高GGT组患者术后1、3、5年的总生存率分别为90.7％、73.7％、66.1％和89.2％、63.6％、43.3％ (P =0.024).COX多因素分析显示:甲胎蛋白≥400 ng/ml、GGT＞ 50 U/L、大血管侵犯、肿瘤最大直径≥10 cm、肿瘤数目≥3个是影响HCC患者术后无瘤生存率的独立风险因素;白蛋白＜35 g/L、GGT＞ 50 U/L、大血管侵犯、肿瘤最大直径≥10 cm、肿瘤数目≥3个是影响HCC患者术后总生存率的独立风险因素.结论 术前血清GGT水平是预测HCC患者肝切除术后肿瘤复发和远期生存的独立预后因素.

abstractsObjective To evaluate the prognostic significance of preoperative serum gamma glutamyl transpeptidase (GGT) level in patients with hepatocellular carcinoma (HCC) after liver resection.Methods A total of 432 patients undergoing hepatectomy for HCC were divided into normal GGT group (175 patients with GGT ≤ 50 U/L) and high GGT group (257 patients with GGT ＞ 50 U/L).After balancing baseline characteristics by propensity score analysis,disease-free survival (DFS) and overall survival (OS) were compared between the two groups.Independent risk factors influencing DFS and OS were identified by Cox multivariate analyses.Results Propensity score analysis identified 124 matched pairs of patients from each group.In the propensity-matched cohort,DFS at 1,3,and 5 years in normal GGT group (69.3％,36.1％,12.8％) was significantly higher than that in high GGT group (60.6％,18.7％,7.5％;P=0.039).OSat1,3,and5 years innommlGGTgroup (90.7％,73.7％,66.1％) was also significantly higher than that in high GGT group (89.2％,63.6％,43.3％;P =0.024).COX multivariate analyses revealed that alpha-fetoprotein ≥400 ng/ml,GGT ＞ 50 U/L,macrovascular invasion,tumor size ≥ 10 cm,and tumor number ≥3 were independent risk factors for DFS in patients with HCC after liver resection.Albumin ＜ 35 g/L,GGT ＞ 50 U/L,macrovascular invasion,tumor size ≥ 10 cm,and tumor number ≥ 3 were identified as independent risk factors for OS.Conclusions Preoperative serum GGT level is an independent factor predicting tumor recurrence and long-term survival in HCC patients after liver resection.