单发肝细胞癌发生微血管侵犯的影响因素及预后分析

胡月雷; 孙大伟; 骆飞翔; 刘欢; 吕国悦

doi:10.3969/j.issn.1001-5256.2018.09.017

单发肝细胞癌发生微血管侵犯的影响因素及预后分析

DOI: 10.3969/j.issn.1001-5256.2018.09.017

吉林大学第一医院肝胆胰脾外一科

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中图分类号: R735.7
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出版历程
- 收稿日期: 2018-03-13
- 出版日期: 2018-09-20

Influencing factors for microvascular invasion in patients with single hepatocellular carcinoma and their prognosis

First Department of Hepatobiliary-pancreatic-splenic Surgery, The First Hospital of Jilin University

摘要

摘要: 目的探讨单发肝细胞癌（SHCC）发生微血管侵犯的影响因素及患者预后情况。方法回顾性分析2012年1月-2014年12月吉林大学第一医院收治的138例行肝癌根治术SHCC患者的临床病理资料。根据中性粒细胞、PLT、纤维蛋白原、中性粒细胞与淋巴细胞比值、PLT与淋巴细胞比值、纤维蛋白原与Alb比值和是否发生微血管侵犯绘制受试者工作特征曲线,依据约登指数确定各指标的临界值。应用logistic回归模型行单因素和多因素分析,比值比（OR）和95%可信区间（95%CI）评价联系的紧密性。对微血管侵犯阳性与阴性患者应用Kaplan-Meier法计算无瘤生存率,并绘制生存曲线,采用log-rank检验进行比较。结果单因素分析显示,与SHCC微血管侵犯相关的因素有性别（OR=0.400,95%CI:0.1620.985,P=0.046）、肿瘤直径（OR=5.902,95%CI:2.81312.382,P<0.001）、AFP（OR=2.635,95%CI:1.2865.398,P=0.008）、中性粒细胞（OR=3.019,95%...
- 癌,肝细胞 /
- 微血管侵犯 /
- 危险因素
Abstract: Objective To investigate the influencing factors for microvascular invasion (MVI) in patients with single hepatocellular carcinoma (SHCC) and their prognosis. Methods A retrospective analysis was performed for the clinical data of 138 patients with SHCC who were admitted to The First Hospital of Jilin University from January 2012 to December 2014 and underwent radical hepatectomy. The receiver operating characteristic curve was plotted based on neutrophil, platelet count (PLT) , fibrinogen, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, fibrinogen-albumin ratio, and presence or absence of MVI. The logistic regression model was used for univariate and multivariate analyses, and odds ratio (OR) and 95% confidence interval (CI) were used to evaluate association. The Kaplan-Meier method was used to calculate disease-free survival rate and plot survival curves of patients with or without MVI, and the log-rank test was used for survival analysis. Results The univariate analysis showed that sex (OR = 0. 400, 95% CI: 0. 162-0. 985, P = 0. 046) , tumor diameter (OR =5. 902, 95% CI: 2. 813-12. 382, P < 0. 001) , alpha-fetoprotein (AFP) (OR = 2. 635, 95% CI: 1. 286-5. 398, P = 0. 008) , neutrophil (OR = 3. 019, 95% CI: 1. 353-6. 736, P = 0. 007) , PLT (OR = 2. 255, 95% CI: 1. 116-4. 555, P = 0. 023) , fibrinogen (OR =3. 483, 95% CI: 1. 687-7. 190, P = 0. 001) , gamma-glutamyl transferase (OR = 2. 115, 95% CI: 1. 069-4. 182, P = 0. 031) , neutrophil-lymphocyte ratio (OR = 3. 662, 95% CI: 1. 803-7. 436, P < 0. 001) , platelet-lymphocyte ratio (OR = 3. 734, 95% CI: 1. 649-8. 455, P = 0. 002) , and fibrinogen-albumin ratio (OR = 3. 014, 95% CI: 1. 497-6. 070, P = 0. 002) were associated with MVI in patients with SHCC. The multivariate analysis indicated that tumor diameter (OR = 5. 423, 95% CI: 2. 555-11. 511, P < 0. 001) and AFP (OR = 2. 195, 95% CI: 1. 010-4. 774, P = 0. 047) were independent factors for MVI. The prognostic analysis showed that the 1-and3-year disease-free survival rates were 66. 4% and 52. 8%, respectively, in patients with MVI and 90. 6% and 71. 5%, respectively, in patients without MVI, and there were significant differences between these two groups of patients (χ2= 10. 929 and 4. 043, both P < 0. 05) .There was also a significant difference in disease-free survival curve between the two groups (χ2= 7. 860, P < 0. 05) . Conclusion Tumor diameter and preoperative AFP level are independent factors for MVI in patients with SHCC, and SHCC patients with MVI tend to have poor prognosis.
- carcinoma, hepatocellular /
- microvascular invasion /
- risk factors

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