肝癌患者手術切除後早期復發危險因子的分析探討

Risk Factor for Early Recurrent Hepatocellular Carcinoma after Hepatectomy

曹素琴(su- Chin Tsao)

指導教授 ： 林俊哲 ； 鄭雅文

中山醫學大學/醫學院/醫學研究所/碩士(2013年)

https://doi.org/10.6834/CSMU.2013.00099

摘要

研究目的：肝癌是國人癌症死亡的重要原因。外科手術治療(包括肝切除及肝臟移植)則是現今被視為最具治癒性與積極性之治療方式，但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。本研究將回顧肝癌患者接受肝切除手術治療之後，術後早期復發的經驗，並加以分析影響其早期復發的危險因子。
研究方法及資料：本研究期間為西元2010年6月到2012年12月間以中部某醫學大學附設醫院接受肝葉切除術之原發性肝癌患者為對象，利用回顧性研究，探討肝癌接受肝葉切除術之肝癌患者，以Cox比例風險回歸進行分析，並評估術後早期復發的相關危險因子。
研究結果：共記錄了68位患者，平均年齡為61.0±5.10歲。手術後一年內復發共22例，其中血小板數低於100,000μL，復發的機率正常者5.32倍；肝腫瘤大小每增加1公分，復發的機率增加4.00倍；有血管侵犯者，肝癌復發的機率為無血管的侵犯者2.70倍；AJCC p TNM stage越晚期，肝癌復發與否的機率為早期者7.50倍；術中出血量多，肝癌復發的機率為出血量少者5.61倍。多變量分析顯示，減少復發存活率的獨立預測因素分別為：術前的血小板數目值低於100,000μL(獨立預測因素：9.29；95%信賴區間為1.34~31.66)；術前的C型肝炎病毒量高於50-100萬以上(獨立預測因素：1.02；95%信賴區間為0.78~1.82)。
結論與建議：本研究主要發現，腫瘤愈大、有血管侵犯者、肝癌分期越晚期及術前血小板數目低及C型肝炎病毒量高、術中出血量多的病患，術後一年內必須更加密切的追蹤。

關鍵字

肝細胞癌 ； 肝切除 ； 早期復發

並列摘要

Objective: Hepatocellular carcinoma (HCC) is a major cause of death for people cancer. Surgery is curative treatment, the recurrence of HCC is still an important factor affecting the prognosis of patients after radical resection, especially the early recurrence of HCC after surgery results in a worse prognosis for patients. Therefore, this study will review the treatment of liver cancer patients receiving liver resection. The early recurrence experience, and analyze the impact of the early risk factors for recurrence.
Methods and Materials: Therefore, this study enrolled the patients with primary HCC who received liver resection in Medical University Hospital. Between June 2010 and December 2012.Retrospective study designs are considered, and use the Cox proportional hazards regression analysis to assess the mechanism of metastasis and recurrence for patients with primary HCC who received liver resection.
Results: Sixty-eight patients who underwent liver resection for HCC were enrolled in this study. During follow-up, twenty-two patients had HCC recurrence, Mean age of these patients at the time of operation was 61.0±5.10 years. The probability of recurrence is 5.32 times normal. The tumor sizes increased by 1 cm, 4-fold increased risk of recurrence. Recurrence rate in patients with vascular invasion is 2.7 times to patients without vascular invasion. Recurrence rate in patients with late AJCC p TNM stage is higher than early stage by 7.5 times. Tumor recurrence rate is 5.61 times in patients who are more intraoperative blood loss. On multivariate analysis, Independent predictors for decreased survival from date of recurrence were (1) preoperative platelet count less than 100,000μL (HR: 9.29；95% CI, 1.34~31.66; P = 0.02), (2) preoperative HCV RNA level than 50-100 million (HR: 1.02；95% CI, 0.78~1.82; P = 0.05).
Conclusion and Suggestion: Our results suggest that close follow-up is mandatory for patients who present with a large tumor burden , Vascular invasion, liver cancer staging the late and preoperative platelet count is low and the amount of HCV RNA patients with blood loss HCC.

並列關鍵字

Hepatocellular carcinoma ； Hepatectomy ； Early Recurrence.

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