影响肝细胞癌腹腔镜肝切除患者预后的相关因素研究

Study on Prognostic Factors of Patients with Hepatocellular Carcinoma Undergoing Laparoscopic Hepatectomy

摘要: 目的：探讨与肝细胞癌腹腔镜肝切除患者预后相关的独立危险因素及其相关指标。方法：回顾性分析青岛大学附属医院2017年1月至2019年12月期间收治的行腹腔镜肝切除术的肝细胞癌患者的临床资料及病理资料。分析影响肝细胞癌腹腔镜肝切除患者预后的危险因素，然后根据其有无危险因素进行分组，比较两组的临床病理资料，分析与危险因素发生相关的临床指标。结果：Cox回归分析结果显示微血管侵犯(microvascular invasion, MVI)是影响肝细胞癌腹腔镜肝切除患者无复发生存率(relapse-free survival, RFS)和总生存率(overall survival, OS)的独立危险因素。MVI阴性组受者术后1、3年OS和RFS分别为98.4%、96.6%和87.3%、64.8%，明显高于MVI阳性组的96.5%、75.2%和63.2%、32.3% (均为P < 0.05)。130例患者中，MVI阴性组患者65例(50%)，MVI阳性组患者65例(50%)。两组患者临床病理资料显示，肿瘤直径越大、分化程度越低、肝被膜侵犯及伴卫星灶比例越高、术前甲胎蛋白(AFP)及总胆红素水平越高，发生MVI的可能性越大(均为P < 0.05)。结论：MVI是影响肝细胞癌腹腔镜肝切除患者预后的独立危险因素，肿瘤直径、分化程度等指标可能与其发生相关。

Abstract: Objective: To explore the independent risk factors and relevant indexes related to the prognosis of patients with hepatocellular carcinoma undergoing laparoscopic hepatectomy. Methods: The clinical and pathological data of patients with hepatocellular carcinoma treated by laparoscopic hepatectomy in the Affiliated Hospital of Qingdao University from January 2017 to December 2019 were analyzed retrospectively. Analyze the independent risk factors affecting the prognosis of patients with hepatocellular carcinoma undergoing laparoscopic hepatectomy, and then group them according to whether they have independent risk factors. Compare the clinical and pathological materials of the two groups, and analyze the clinical indicators related to the occurrence of independent risk factors. Results: Cox regression analysis showed that MVI was an independent risk factor for RFS and OS in patients undergoing laparoscopic hepatectomy for hepatocellular carcinoma. The 1-year and 3-year overall survival (OS) and recurrence free survival (RFS) in MVI negative group were 98.4%, 96.6% and 87.3%, 64.8% respectively, which were significantly higher than 96.5%, 75.2% and 63.2%, 32.3% in MVI positive group (all P < 0.05). Among the 130 patients, there were 65 patients (50%) in the MVI negative group and 65 patients (50%) in the MVI positive group. The clinical pathological data of the two groups showed that the larger the tumor diameter, the lower the degree of differentiation, the higher the proportion of liver envelope invasion and satellite lesions, and the higher the preoperative level of alpha fetoprotein (AFP) and total bilirubin, the greater the possibility of MVI (all P < 0.05). Conclusion: MVI is an independent risk factor affecting the prognosis of patients undergoing laparoscopic hepatectomy for hepatocellular carcinoma. Tumor diameter, degree of differentiation and other indicators may be related to its occurrence.