中国实用外科杂志

中国实用外科杂志 ›› 2021, Vol. 41 ›› Issue (10): 1168-1172.DOI: 10.19538/j.cjps.issn1005-2208.2021.10.13

• 论蓍 • 上一篇    下一篇

混合型肝癌预后评价及相关影响因素分析

  

  1. 海军军医大学东方肝胆外科医院肝外六科，上海 200433
  • 出版日期:2021-10-01 发布日期:2021-10-19

杨施晔，郭    磊，冯锦凯，程树群，郭卫星   

  • Online:2021-10-01 Published:2021-10-19

摘要： 目的    评价混合型肝癌（cHCC-CC）病人的预后并分析与预后相关的影响因素。方法    回顾性分析2015年9月至2019年9月海军军医大学东方肝胆外科医院收治的54例cHCC-CC病人的临床资料。随访观察3年，采用Kaplan-Meier法进行生存分析，并分析cHCC-CC病人预后的影响因素。结果    54例cHCC-CC病人术后1、2、3年总体生存率为84.7%、61.1%、47.0%，无病生存率为50.8%、46.9%、26.4%，中位生存期（OS）、无病生存期（DFS）分别为29.1、17.7个月。单因素分析显示，肿瘤最大径≥5 cm、微血管侵犯、淋巴结转移为OS和DFS的影响因素。Cox多因素分析显示，肿瘤最大径≥5 cm（P=0.035）、微血管侵犯（P=0.023）、淋巴结转移（P=0.041）为OS的独立危险因素；微血管侵犯（P=0.007）、淋巴结转移（P=0.024）是DFS的独立危险因素。结论  cHCC-CC预后较差，兼有肝细胞癌及胆管细胞癌的特点，肿瘤直径≥5 cm、微血管侵犯及淋巴结转移影响病人预后生存，建议据此选择个体化治疗方案。

关键词: 混合型肝癌, 微血管侵犯, 因素分析, 生存, 预后

Abstract: Analysis of prognosis and related risk factors of combined hepatocellular carcinoma and cholangiocarcinoma             YANG Shi-ye，GUO Lei，FENG Jin-kai，et al. Department of Hepatic Surgery VI，Eastern Hepatobiliary Surgery Hospital，Naval Medical University，Shanghai 200433，China
Corresponding author：Guo Wei-xing，E-mail：weixingg88@126.com
Abstract  Objective    To observe the prognosis of patients with combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) and analyse the risk factors. Methods    Clinical data of 54 cHCC-CC patients in Eastern Hepatobiliary Surgery Hospital of Naval Medical University from September 2015 to September 2019 were retrospectively analyzed. Kaplan-Meier survival analysis was performed with SPSS26.0 software，and survival curves were drawn. Univariate analysis and Cox multivariate analysis were performed. Follow-up investigations were conducted for 3 years after discharge from the hospital. The effect of potential risk factors on the prognosis of patients with cHCC-CC was analyzed according to the results. Results    The overall survival  at 1，2 and 3 years after surgery was 84.7%，61.1%，47.0%，respectively，whereas the disease-free survival at 1，2 and 3 years after surgery was 50.8%，46.9%，26.4%，respectively. Median survival and median recurrence time were 29.1 and 17.7 months，respectively. Univariate analysis showed that maximum tumor diameter ≥5 cm，microvascular invasion and lymph node metastasis were influencing factors of OS and DFS. Cox multivariate analysis showed that maximum tumor size ≥5 cm (P=0.035)，microvascular invasion (P=0.023) and lymph node metastasis (P=0.041) were independent risk factors of OS. Microvascular invasion (P=0.007) and lymph node metastasis (P=0.024) were independent risk factors of DFS. Conclusion    cHCC-CC is a highly malignant disease，harboring the characteristics of hepatocellular carcinoma and cholangiocarcinoma. This study demonstrated that maximum tumor diameter ≥ 5 cm，presence of microvascular invasion and lymph node metastasis will affect the prognosis of these patients. Therefore，Individualized treatment should be carried out according to these specific treatment indicators.

Key words: combined hepatocellular carcinoma and cholangiocarcinoma, microvascular invasion, factor analysis, survival, prognosis