- 期刊
肝癌術後早期復發的危險因子的探討
Analysis of Risk Factors of Early Recurrence of Hepatocellular Carcinoma after Surgical Resection
摘要
肝癌是國人癌症死亡的重要原因。手術切除較可能達成根治性的目的，因此目前肝癌的主要治療方式為手術切除。雖然手術切除可達到根治性的目的，但是肝癌的復發仍是影響病人預後的重要因素。尤其是肝癌術後的早期復發(early recurrence)影響病人預後更甚。本研究從西元2002年12月到2005年11月，三年間回溯性分析外科根治性手術治療肝癌的病人。在這三年裏共記錄了84例患者。其中男性68例(81.0%)，女性16例(19.0%)，平均年齡為59.0±11.94歲。最常見的臨床表徵是右上腹痛有10例(11.9%)，其他的臨床症狀包括上腹痛6例(7.1%)，肝膿瘍1例(1.2%)，而完全沒有症狀有37例(44.0%)。手術後一年內復發共35例，其中病人的術前肝腫瘤大小、術前的胎兒蛋白(AFP)、是否有飲酒史等變項和肝癌手術後早期復發有顯著相關。肝腫瘤大小每增加1公分，肝癌術後早期復發的機率增加28%（復發危險比：1.28；95%信賴區間為1.054-1.550）；術前的胎兒蛋白(AFP)值不正常者，肝癌術後早期復發的機率為兒蛋白值正常者3.40倍（95%信賴區間為1.229-9.408）；有飲酒史者，肝癌術後早期復發的機率為無飲酒史者3.9倍（95%信賴區間為1.297-11.697）；B及C型肝炎則與肝癌術後早期復發無顯著相關。根據我們的研究結果，腫瘤愈大及合併酒精性肝炎的病患，術後一年內必須更加密切的追蹤。
並列摘要
This study was performed to identify the risk factors for early recurrence of hepatocellular carcinoma (HCC) after resection. Eighty-four patients who underwent liver resection for HCC were enrolled in this study. Demographic data, biochemical tests, tumor characteristics, and history of heavy alcohol intake were evaluated by univariate and multivariate analyses to identify risk factors associated with early recurrence after resection. During follow-up, thirty-five patients had HCC recurrence, and the male-to-female ratio was 28:7. Mean age of these patients at the time of operation was 59.0±13.8 years. Tumor size, preoperative alpha-fetoprotein (AFP) level and heavy alcohol intake were associated with increased cumulative risk of early HCC recurrence. By multivariate analysis, tumor size (P=0.001, odds ratio [OR]=1.28, 95% CI=1.054-1.550), AFP level ≧6.00 ng/mL (P=0.02, OR=3.4, 95% CI=1.229-9.408), and heavy alcohol intake (P=0.015, OR=3.9, 95% CI=1.297-11.697) were found to be independent risk factors. In conclusion, our results suggest that close follow-up is mandatory for patients who present with a large tumor burden or alcohol-related HCC.
被引用紀錄
延伸閱讀
- 薛冠群（2018）。探討肝臟移植或手術切除對早期肝癌患者的影響〔博士論文，中山醫學大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0003-2106201811312900
- Hsu, H. M., Liu, Y. C., Chen, T. W., & Chao, D. G. (1999). 肝癌合併膽管癌：一病例報告及文獻回顧. Journal of Medical Sciences, 20(2), 84-89. https://www.airitilibrary.com/Article/Detail?DocID=10114564-199910-201305270005-201305270005-84-89
- 何香毅（2012）。晚期肝癌住院病人嚴重藥物不良反應預測因子與存活之探討〔碩士論文，國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342/NTU.2012.01935
- 林麗絲、謝佳恩、王思涵、柯志燃、林國華、林佳正、林屏沂、陳堯俐（2017）。肝癌患者行切肝合併膽囊切除手術後腹瀉之危險因子探討。台灣醫學，21(3)，250-256。https://doi.org/10.6320/FJM.2017.21(3).2
- Ko, C. J., Lin, K. H., Lin, P. Y., Ko, T. Y., Chen, Y. L., & Kuo, S. J. (2014). Predictors of Survival among Young Adult Patients with Early Recurrence of Hepatocellular Carcinoma after Hepatectomy. The Changhua Journal of Medicine, 12(1), 1-8. https://www.airitilibrary.com/Article/Detail?DocID=16801504-201403-201411060022-201411060022-1-8