微血管侵犯阳性肝癌病人肝切除肿瘤复发的危险因素分析

苏展; 杨为中; 车金辉; 周武元

doi:10.13898/j.cnki.issn.1000-2200.2021.01.024

微血管侵犯阳性肝癌病人肝切除肿瘤复发的危险因素分析

Analysis of the risk factors of tumor recurrence in hepatocellular carcinoma patients with positive microvascular invasion treated with hepatectomy

摘要

摘要:
目的研究微血管侵犯(MVI)阳性肝癌病人肝切除肿瘤复发的危险因素。
方法选择肝癌病人60例作为研究对象，根据手术病理结果分为MVI阳性组20例和MVI阴性组40例。比较2组病人一般资料、术后并发症发生情况和随访12个月的复发率、死亡率，分析MVI阳性肝癌病人肝切除肿瘤复发的危险因素。
结果MVI阳性组和MVI阴性组病人性别、年龄、病理类型、手术切缘、解剖性肝切除、肝硬化、肝炎、肝功能Child-Pugh分级差异均无统计学意义(P>0.05)，2组肿瘤分化程度、肿瘤最大径、肿瘤边缘是否光滑、肿瘤包膜是否完整、甲胎蛋白水平差异均有统计学意义(P < 0.05~P < 0.01)。MVI阳性组病人术后并发症发生率为20.00%(4/20)，与MVI阴性组的7.50%(3/40)比较差异无统计学意义(P>0.05)。随访12个月，MVI阳性组病人复发率25.00%(5/20)，高于MVI阴性组的5.00%(2/40)(P < 0.05)；MVI阳性组病人死亡率10.00%(2/20)，与MVI阴性组的5.00%(2/40)差异无统计学意义(P>0.05)。多因素logistic回归分析显示，肿瘤低分化、肿瘤最大径>5 cm、肿瘤边缘不光滑、无肿瘤包膜、甲胎蛋白水平>400 μg/L均为MVI阳性肝癌的独立危险因素(P < 0.05~P < 0.01)。
结论MVI阳性肝癌病人肝切除后复发率比MVI阴性肝癌病人更高，且与肿瘤分化程度、肿瘤直径、肿瘤边缘及包膜、AFP相关。

Abstract:
ObjectiveTo study the risk factors for tumor recurrence in hepatocellular carcinoma patients with positive microvascular invasion(MVI) treated with hepatectomy.
MethodsSixty patients with liver cancer were divided into the MVI-positive group(20 cases) and MVI-negative group(40 cases) according to the surgical pathological results.The basic data, postoperative complications, and recurrence rate and mortality after 12-month of following-up were compared between two groups.The risk factors of tumor recurrence in hepatocellular carcinoma patients with positive MVI treated with hepatectomy were analyzed.
ResultsThe differences of the gender, age, pathological type, surgical margin, anatomical hepatectomy, cirrhosis, hepatitis and liver function Child-Pugh classification between two groups were not statistically significant(P>0.05).The differences of the degree of tumor differentiation, maximum diameter of tumor, smooth edge of tumor, integrity of tumor envelope and level of α-fetoprotein(AFP) were statistically significant(P < 0.05 to P < 0.01).The postoperative complication rate in the MVI-positive group and MVI-negative group were 20.00% and 7.50%, respectively, and the difference of which between two groups was not statistically significant(P>0.05).After 12 months of following-up, the recurrence rate of tumor in MVI-positive group(25.00%) was higher that in MVI-negative group(5.00%)(P < 0.05).The difference of the mortality rate between the MVI-positive group(10.00%) and MVI-negative group(5.00%) was not statistically significant(P>0.05).The results of multivariate logistic regression analysis showed that the low differentiation, maximum diameter >5 cm, non-smooth edge, tumor-free capsule and AFP>400 g/L were the dependent risk factors of MVI-positive liver cancer(P < 0.05 to P < 0.01).
ConclusionsThe recurrence rate of MVI-positive liver cancer patients after hepatectomy is higher than that of MVI-negative liver cancer patients, and mainly related to the degree of tumor differentiation, tumor diameter, tumor margin, capsule and AFP level.

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