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

详细信息

中图分类号: R735.7
计量
- 文章访问数: 2018
- HTML全文浏览量: 30
- PDF下载量: 366
- 被引次数: 0
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

HTML全文

参考文献(31)

[1]PERZ JF, ARMSTRONG GL, FARRINGTON LA, et al.The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide[J].J Hepatol, 2006, 45 (4) :529-538.

[2]FORNER A, LLOVET JM, BRUIX J.Hepatocellular carcinoma[J].Lancet, 2012, 379 (9822) :1245-1255.

[3]National Health and Family Planning Commission of the People's Republic of China.Diagnosis, management, and treatment of hepatocellular carcinoma (V2017) [J].J Clin Hepatol, 2017, 33 (8) :1419-1431. (in Chinese) 中华人民共和国国家卫生和计划生育委员会.原发性肝癌诊疗规范 (2017年版) [J].临床肝胆病杂志, 2017, 33 (8) :1419-1431.

[4]Chinese Society of Liver Cancer, Chinese Anti-Cancer Association;Liver Cancer Study Group, Chinese Society of Hepatology, Chinese Medical Association;Chinese Society of Pathology, Chinese Anti-Cancer Association, et al.Evidence-based practice guidelines for the standardized pathological diagnosis of primary liver cancer in China (2015 update) [J].J Clin Hepatol, 2015, 31 (6) :833-839. (in Chinese) 中国抗癌协会肝癌专业委员会, 中华医学会肝病学分会肝癌学组, 中国抗癌协会病理专业委员会, 等.原发性肝癌规范化病理诊断指南 (2015年版) [J].临床肝胆病杂志, 2015, 31 (6) :833-839.

[5]AHN SY, LEE JM, JOO I, et al.Prediction of microvascular invasion of hepatocellular carcinoma using gadoxetic acid-enhanced MR and (18) F-FDG PET/CT[J].Abdom Imaging, 2015, 40 (4) :843-851.

[6]HU H, ZHENG Q, HUANG Y, et al.A non-smooth tumor margin on preoperative imaging assesses microvascular invasion of hepatocellular carcinoma:A systematic review and meta-analysis[J].Sci Rep, 2017, 7 (1) :15375.

[7]REGINELLI A, VANZULLI A, SGRAZZUTTI C, et al.Vascular microinvasion from hepatocellular carcinoma:CT findings and pathologic correlation for the best therapeutic strategies[J].Med Oncol, 2017, 34 (5) :93.

[8]YANG C, WANG H, TANG Y, et al.ADC similarity predicts microvascular invasion of bifocal hepatocellular carcinoma[J].Abdom Radiol (NY) , 2018.[Epub ahead of print]

[9]HYUN SH, EO JS, SONG BI, et al.Preoperative prediction of microvascular invasion of hepatocellular carcinoma using 18F-FDGPET/CT:A multicenter retrospective cohort study[J].Eur J Nucl Med Mol Imaging, 2018, 45 (5) :720-726.

[10]EGUCHI S, TAKATSUKI M, HIDAKA M, et al.Predictor for histological microvascular invasion of hepatocellular carcinoma:A lesson from 229 consecutive cases of curative liver resection[J].World J Surg, 2010, 34 (5) :1034-1038.

[11]FAN LF, ZHAO WC, YANG N, et al.Alpha-fetoprotein:The predictor of microvascular invasion in solitary small hepatocellular carcinoma and criterion for anatomic or non-anatomic hepatic resection[J].Hepatogastroenterology, 2013, 60 (124) :825-836.

[12]SHIRABE K, ITOH S, YOSHIZUMI T, et al.The predictors of microvascular invasion in candidates for liver transplantation with hepatocellular carcinoma-with special reference to the serum levels of des-gamma-carboxy prothrombin[J].J Surg Oncol, 2007, 95 (3) :235-240.

[13]POTN, CAUCHY F, ALBUQUERQUE M, et al.Performance of PIVKA-II for early hepatocellular carcinoma diagnosis and prediction of microvascular invasion[J].J Hepatol, 2015, 62 (4) :848-854.

[14]REN Y, POON RT, TSUI HT, et al.Interleukin-8 serum levels in patients with hepatocellular carcinoma:Correlations with clinicopathological features and prognosis[J].Clin Cancer Res, 2003, 9 (16 Pt 1) :5996-6001.

[15]CAO GL, CAI Q, LI YA, et al.Risk factors analysis and prognosis of the microvascular invasion of hepatocellular carcinoma[J].Chin J Dig Surg, 2017, 16 (10) :1048-1052. (in Chinese) 曹国良, 蔡庆, 李幼安, 等.肝细胞癌微血管侵犯的危险因素分析及预后[J].中华消化外科杂志, 2017, 16 (10) :1048-1052.

[16]YU Y, SONG J, ZHANG R, et al.Preoperative neutrophil-tolymphocyte ratio and tumor-related factors to predict microvascular invasion in patients with hepatocellular carcinoma[J].Oncotarget, 2017, 8 (45) :79722-79730.

[17]BRUIX J, SHERMAN M;Practice Guidelines Committee, American Association for the Study of Liver Diseases.Management of hepatocellular carcinoma[J].Hepatology, 2005, 42 (5) :1208-1236.

[18]RODRGUEZ-PERLVAREZ M, LUONG TV, ANDREANA L, et al.A systematic review of microvascular invasion in hepatocellular carcinoma:Diagnostic and prognostic variability[J].Ann Surg Oncol, 2013, 20 (1) :325-339.

[19]ZHAO H, HUA Y, LU Z, et al.Prognostic value and preoperative predictors of microvascular invasion in solitary hepatocellular carcinoma≤5 cm without macrovascular invasion[J].Oncotarget, 2017, 8 (37) :61203-61214.

[20]RENZULLI M, BROCCHI S, CUCCHETTI A, et al.Can current preoperative imaging be used to detect microvascular invasion of hepatocellular carcinoma?[J].Radiology, 2016, 279 (2) :432-442.

[21]ZHENG J, SEIER K, GONEN M, et al.Utility of serum inflammatory markers for predicting microvascular invasion and survival for patients with hepatocellular carcinoma[J].Ann Surg Oncol, 2017, 24 (12) :3706-3714.

[22]IMURA S, TERAOKU H, YOSHIKAWA M, et al.Potential predictive factors for microvascular invasion in hepatocellular carcinoma classified within the Milan criteria[J].Int J Clin Oncol, 2018, 23 (1) :98-103.

[23]HUSSAIN SP, HARRIS CC.Inflammation and cancer:An ancient link with novel potentials[J].Int J Cancer, 2007, 121 (11) :2373-2380.

[24]OUYANG B, QIU YL, WANG YX, et al.Study of TSGF, AFPand GGT in the diagnosis of primary hepatic carcinoma[J].Shenzhen J Integr Tradit Chin West Med, 2016, 26 (5) :6-8. (in Chinese) 欧阳彬, 丘燕丽, 汪云霞.TSGF、AFP、GGT联合诊断原发性肝癌的临床价值[J].深圳中西医结合杂志, 2016, 26 (5) :6-8.

[25]WEI X, LI N, LI S, et al.Hepatitis B virus infection and active replication promote the formation of vascular invasion in hepatocellular carcinoma[J].BMC Cancer, 2017, 17 (1) :304.

[26]ZHENG B, ZHU YJ, WANG HY, et al.Gender disparity in hepatocellular carcinoma (HCC) :Multiple underlying mechanisms[J].Sci China Life Sci, 2017, 60 (6) :575-584.

[27]RUGGIERI A, BARBATI C, MALORNI W.Cellular and molecular mechanisms involved in hepatocellular carcinoma gender disparity[J].Int J Cancer, 2010, 127 (3) :499-504.

[28]BAI SL, YANG PH, LI J, et al.Effect of microvascular invasion on postoperative long-term prognosis of small and large hepatocellular carcinoma[J/CD].Chin J Hepatic Surg:Electronic Edition, 2017, 6 (3) :207-211. (in Chinese) 白石磊, 杨平华, 李俊, 等.微血管侵犯对小肝细胞癌和大肝细胞癌术后远期预后的影响[J/CD].中华肝脏外科手术学电子杂志, 2017, 6 (3) :207-211.

[29]SHEN J, LI C, YAN L, et al.Short-and long-term outcomes between young and older HCC patients exceeding the milan criteria after hepatectomy[J].Ann Hepatol, 2018, 17 (1) :134-143.

[30]HUANG C, ZHU XD, JI Y, et al.Microvascular invasion has limited clinical values in hepatocellular carcinoma patients at Barcelona Clinic Liver Cancer (BCLC) stages 0 or B[J].BMC Cancer, 2017, 17 (1) :58.

[31]CHENG Y, JIA WD, XING SG, et al.Clinical efficacy of anatomic liver resection in the treatment of hepatocellular carcinoma with microvascular invasion[J].Chin J Dig Surg, 2017, 16 (2) :144-150. (in Chinese) 程亚, 荚卫东, 邢松歌, 等.解剖性肝切除术治疗合并微血管侵犯肝细胞癌的临床疗效[J].中华消化外科杂志, 2017, 16 (2) :144-150.

施引文献

资源附件(0)

访问统计