标题：原发性肝细胞癌术后早期转移复发的相关因素分析

      作者：黄晓曦，江雪梅，刘英，成建斌，陈小朋，余湘南，林松挺，陈正义    (海口市人民医院中南大学湘雅医学院附属海口医院消化内科，海南 海口 570208)

      卷次： 2016年27卷23期

      【摘要】 目的 分析原发性肝细胞癌术后早期转移复发的相关因素。方法 对2006年1月至2015年1月行肝癌切除术且术后病理确诊为肝细胞癌的93例患者进行回顾性研究。将手术后1年内出现转移复发者纳入复发组，1年内未出现转移复发者纳入未复发组。分析性别、年龄、乙肝表面抗原、甲胎蛋白(AFP)、糖类蛋白肿瘤标志物19-9 (CA19-9)、血糖、谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰胺转肽酶(GGT)、总胆红素、白蛋白、国际标准化值(INR)、凝血酶原时间 (PT)、是否合并肝硬化、肝功能Child-Pugh分级、肿瘤大小、位置、数目、是否侵犯血管、包膜是否完整、病理分化程度、肝癌CLIP评分、肝癌TNM分期等 23个因素对原发性肝癌术后早期转移复发的影响。结果 年龄、AFP、CA19-9、ALT、AST、GGT、总胆红素、白蛋白、INR、肿瘤大小、肿瘤包膜是否完整、肝癌CLIP评分、肝癌TNM分期等 13个因素经单因素生存分析，差异均有统计学意义(P<0.05)，而年龄、AFP、CA19-9、ALT、AST、GGT、总胆红素、肝癌CLIP评分、肝癌TNM分期等9个因素，差异均有显著统计学意义(P<0.01)；AFP、肿瘤大小、肝癌的CLIP评分经多因素生存分析，差异均有统计学意义(P值分别为 0.048、0.006和 0.003)。结论 年龄、CA19-9、ALT、AST、GGT、总胆红素、白蛋白、INR、肿瘤包膜是否完整、肝癌TNM分期等因素是肝癌术后早期转移复发的危险因素；AFP、肿瘤大小、肝癌的CLIP评分是肝癌切除术后早期转移复发的独立危险因素。
      【关键词】 原发性肝细胞癌；肝癌切除术；转移复发；危险因素
      【中图分类号】 R735.7 【文献标识码】 A 【文章编号】 1003—6350（2016）23—3857—03

Analysis of risk factors contributing to early metastasis and recurrence of primary hepatocellular carcinomaafter hepatactomy.
HUANG Xiao-xi, JIANG Xue-mei, LIU Ying, CHENG Jian-bin, CHEN Xiao-peng, YU Xiang-nan,LIN Song-ting, CHEN Zheng-yi. Department of Neurosurgery, Haikou People's Hospital Affiliated to Xiangya MedicalSchool of Central South University, Haikou 570208, Hainan, CHINA
【Abstract】 Objective To analyze the related factors of early metastasis and recurrence of primary hepatocellu-lar carcinoma after hepatactomy. Methods From January 2006 to January 2015, ninety-three patients pathologicallyconfirmed as primary liver cancer after hepatectomy were retrospectively analyzed. The patients who had metastasis andrecurrence in one year after hepatectomy were divided into the recurrent group, and those who did not were divided intothe non-recurrent group. Twenty-three factors including gender, age, hepatitis B surface antigen, α-fetoprotein (AFP),carbohydrate antigen 19-9 (CA19-9), blood glucose, alanine aminotransferase (ALT), aspartate aminotransferase (AST)and gamma-glutamyl transferase (GGT), total bilirubin, albumin, international normalized ratio (INR), prothrombin time(PT), whether with cirrhosis, Child-Pugh grading of liver function, tumor size, tumor location, tumor number, whether tu-mor invading vessels, the completeness degree of tumor capsule, pathological differentiation degree of tumor, cancer ofthe liver italian program (CLIP) scoring and liver cancer tumor-node-metastasis (TNM) staging system were analyzed.Results Univariate survival analysis showed that there were differences on 13 related factors: age, AFP, CA19-9,ALT, AST, GGT, total bilirubin, albumin, INR, tumor size, the completeness degree of tumor capsule, liver cancer CLIPscoring, liver cancer TNM staging (P<0.05). There were significant differences on 9 related factors including age, AFP,CA19-9, ALT, AST, GGT, total bilirubin, liver cancer CLIP scoring, liver cancer TNM staging (P<0.01). Multivariatesurvival analysis showed that there were differences in AFP, liver cancer CLIP scoring, tumor size (P=0.048, P=0.006,P=0.003, respectively). Conclusion Age, CA19-9, ALT, AST, GGT, total bilirubin, albumin, INR, the completeness de-gree of tumor capsule, liver cancer TNM staging are the risk factors of early metastasis and recurrence after hepatectomyfor hepatocellular carcinoma. AFP, tumor size, liver cancer CLIP scoring are the independent risk factors.
      【Key words】 Primary hepatocellular carcinoma; Hepatectomy; Metastasis and recurrence; Risk factors·论 著·doi:10.3969/j.issn.1003-6350.2016.23.023基金项目：海南省卫计委2012年度医学科研立项课题(编号：琼卫2012PT-45)