早期肝癌術後之復發危險因子分析

Analysis of the Recurrence Risk Factors for Early Stage Hepatocellular Carcinoma after Hepatectomy

何瓊楣(Chiung-Mei Ho)

指導教授 ： 許國堂

中山醫學大學/醫學院/醫學研究所/碩士(2015年)

https://doi.org/10.6834/CSMU.2015.00001

摘要

研究目的：肝細胞癌是全球常見的癌症，特別是亞太地區，理論上肝移植是最好的選擇，因為肝移植可治療肝癌和末期肝疾病，其總體生存率5年約70-75%，但是常不可得。在相比之下，肝切除術5年生存率只有40%-65%，且10年存活率為29%。肝癌術後復發率高是一個嚴重的問題。復發率3年50-60%，5年70-100%，這種高復發率妨礙肝癌術後長期無病生存期。所以本研究將回顧早期肝癌患者接受肝切除手術治療之後，術後復發的記錄，並加以分析影響其復發的危險因子。
研究方法及資料：本研究從西元2010年6月到2015年02月四年多期間以中部某醫學大學附設醫院，以早期原發性肝癌患者接受肝切除術為對象，利用回顧性研究，探討肝癌接受肝切除術之肝癌患者，以邏輯氏迴歸進行分析，並評估術後復發的相關危險因素。
研究結果：在這四年多期間共記錄了89位患者，平均年齡為61.6歲。手術後復發共28例， 有B型肝炎患者和無使用解剖性的肝切除患者，術後必須更加密切的追蹤，有B型肝炎患者，肝癌復發與否的機率為沒有肝炎者10.476倍(復發危險比：10.476；95%信賴區間為0.928~118.245)；沒有使用解剖性切除者，肝癌復發與否的機率為有使用解剖性切除者3.072倍(復發危險比：3.072；95%信賴區間為1.018~9.268)。
結論與建議：根據我們的研究發現，有B型肝炎病患和無使用解剖性的肝切除患者術後必須更加密切的追蹤，復發的機率較高。

關鍵字

早期肝癌 ； 肝炎 ； 肝硬化 ； 肝切除 ； 復發

並列摘要

Objective: Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, especially in the Asia pacific area. Liver transplantation is theoretically the best option because it cures HCC and the underlying liver disease. The overall survival rate at 5 years after liver transplantation was around 70-75%. In contrast, 5-year survival rates after liver resection were only 40% to 65%, and the 10-year survival rate was 29%. The high incidence of HCC recurrence following liver resection is a serious issue. The recurrent rate is as high as 50-60% at 3 years and 70-100% at 5 years. This high recurrent rate precludes long-term tumor-free survival of the patients with liver resection for HCC. Our study reviewed the treatment of liver cancer patients receiving liver resection and their recurrence experience to analyze the impact of the risk factors for recurrence.
Methods and Materials: This study enrolled the patients with early primary HCC who received liver resection in Medical University Hospital from June 2010 to February 2015. Retrospective study designs are applied. The data were evaluated with a logical formula regression analysis, and assess the risk factors that associated with recurrence followed by discussion.
Results: We recorded a total of 89 patients with a mean age of 61.6 years. Total of 28 cases relapse after surgery. There are hepatitis B patients with and without the use of anatomical liver resection in patients must be more closely tracked. The probability of cancer recurrence that with hepatitis B is 10.476 times compared with no hepatitis B (recurrence hazard ratio: 10.476 ; 95% confidence interval, 0.928 - 118.245); the probability of cancer recurrence that not using anatomical resection, is 3.072 times (recurrence hazard ratio: 3.072; 95% confidence interval, 1.018 - 9.268) compared with have anatomical resection.
Conclusion and Suggestion: According to our study, hepatitis B patients and patients without using anatomical liver resection must be more closely tracked; because of these two groups of patients have the higher probability of cancer relapse.

並列關鍵字

Early hepatocellular carcinoma ； Hepatitis ； Liver cirrhosis ； Hepatectomy ； Recurrence.

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