肝癌病患中，C-反應蛋白在存活率及預後結果的分析

Pre-operative C-Reactive Protein as a Prognostic Factor after Surgical Resection of Hepatocellular Carcinoma

廖建洲(Jian-Jhou Liao)

指導教授 ： 周明智

中山醫學大學/醫學院/醫學研究所/碩士(2016年)

摘要

目的：本研究主要是探討術前C-反應蛋白值對於肝癌接受肝腫瘤切除病人的預後價值。
方法：在2007年1月至2012年12月，在台中榮民總醫院總共有767位之前未接受任何治療的病人接受外科手術切除肝癌。其中，排除了非肝細胞癌的肝腫瘤、非根治性切除、手術相關死亡病例。總共有 649位肝癌病人列入分析。把收案病人分成兩組: CRP-negative group (group A: serum CRP level <0.3 mg/dl, n=378)和CRP-positive group (group B: serum CRP level ≥0.3 mg/dl, n=271)。使用單變量分析及多變量分析來分析會影響無復發存活率(recurrence-free survival (RFS))及總存活率(overall survival (OS))的獨立因子。
結果：在Group A其1年、3年、5年的cumulative OS rate分別是95.5%、87.6和78.4%；而Group B分別是81.2%、70.5和51.2% (p<0.00l)。在Group A其1年、3年、5年的cumulative RFS rate分別是70.2%、42.3%和32.2%；而Group B分別是51.5%、32.3和27.7% (p<0.00l)。在多變項分析中，術前的CRP值是手術切除後的總存活率OS的獨立預測因子。
結論：術前CRP值，在針對手術切除後的總存活率OS，是一項有用的預測因子，提供了合理的理由對於使用CRP值在肝細胞癌病人的將來臨床應用上。

關鍵字

C反應蛋白 ； 肝細胞癌 ； 外科手術切除 ； 預後因子

並列摘要

Background: The study aimed to examine the prognostic value of pre-operative serum C-reactive protein(CRP) levels after surgical resection for hepatocellular carcinoma (HCC).

Method: Six hundred forty-nine patients who underwent curative resection for HCC were reviewed retrospectively. Clinicopathologic variables were compared between patients with serum CRP levels < 0.3 mg/dL (n = 378 patients; the CRP-negative group) and patients with serum CRP levels >/= 0.3 mg/dL (n = 271 patients; the CRP-positive group). Univariate and multivariate analyses were conducted to identify factors that affected survival and disease recurrence.

Results: The 1- and 3-year cumulative OS rates were 95.5% and 87.6% in group A and 81.2% and 70.5% in group B (p<0.00l). The corresponding RFS rates were 70.2% and 42.3% in group A and 51.5% and 32.3% in group B (p<0.00l). In multivariate analysis, the pre-operative CRP level was a significant prognostic factor linked to OS (p=0.001).

Conclusion: Pre-operative CRP levels may be a useful prognostic factor after surgical resection for HCC.

並列關鍵字

C-Reactive protein ； hepatocellular carcinoma ； surgical resection ； prognostic factor

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