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微血管侵犯分级对肝细胞癌行根治性肝切除术后早期复发的预测价值
Value of microvascular invasion grade in predicting the early recurrence of hepatocellular carcinoma after radical hepatectomy
文章发布日期:2020年07月09日  来源:  作者:何旭昶,安文慧,曾庆彬,等  点击次数:676次  下载次数:43次

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【摘要】:目的 回顾性分析肝细胞癌术后患者的预后,研究微血管侵犯(MVI)分级与经典临床肿瘤分期(TNM分期、BCLC分级)在肝细胞癌术后早期复发预测价值上的差异,进而探讨MVI分级的临床价值。方法 选取2015年12月-2017年12月在昆明医科大学第二附属医院肝胆外科进行根治性肝切除术治疗的HCC患者共100例,根据随访2年后的结果,分为复发组(n=49)和未复发组(n=51)。比较2组患者的实验室指标及MVI分级情况;比较MVI分级、TNM分期和BCLC分级在预测患者术后2年无复发生存期的价值。符合正态分布计量资料2组间比较采用t检验;不符合正态分布的计量资料2组间比较采用Mann-Whitney U检验。计数资料2组间非等级资料比较采用χ2检验,等级资料比较采用Mann-Whitney U检验;3组间比较采用Kruskai-Wallis H检验,进一步两两比较采用Bonferroni法。Kaplan-Meier法绘制生存曲线,log-rank检验进行比较。通过rms包计算一致性指数进行各临床病理分期预测价值的比较。结果 与未复发组比较,复发组患者AFP水平更高(Z=0.099,P<0.05)、发生MVI更多(Z=-2.651,P=0.008)。随访2年后,100例患者中M0组47例,M1组34例,M2组19例。M0级复发18例(38.3%),M1级复发16例(47.1%),M2级复发15例(78.9%),3组间复发情况比较差异有统计学意义(H=8.934,P=0.011),进一步两两比较,M2级患者复发比例均高于M0级和M1级(P值均<0.05)。MVI分级为M0+M1患者累计复发率41.9% ,M2患者累计复发率78.9% ,2组比较差异有统计学意义(χ2=11.445,P<0.001),M2级2年RFS较M0+M1级减少;BCLC分级为早期(0期+1期)患者累计复发率36.2% ,中晚期(2期+3期)累计复发率66.7% ,2组比较差异有统计学意义(χ2=5.047,P=0.012),中晚期组2年RFS较早期组减少;TNM分期为I期的患者累计复发率24.5%,Ⅱ+Ⅲ期累计复发率72.5%,2组比较差异有统计学意义(χ2=17.223,P<0.001),Ⅱ+Ⅲ期组2年RFS较Ⅰ期组减少。在2年无复发生存期的预测价值上,TNM分期的预测价值最高,而MVI与BCLC的预测价值则差别较小(一致性指数:0.659 vs 0.598 vs 0.600)。结论 相较于无风险及低风险的MVI患者,高风险MVI的患者在早期复发的几率显著上升,MVI或许可作为术后治疗的评估指标。
【Abstract】:Objective To investigate the value of microvascular invasion (MVI) grade versus TNM stage and Barcelona Clinic Liver Cancer (BCLC) stage in predicting the early recurrence of hepatocellular carcinoma (HCC) after radical hepatectomy and the clinical value of MVI grade through a retrospective analysis of the prognosis of patients after HCC surgery. Methods A total of 100 HCC patients who underwent radical hepatectomy in Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, from December 2015 to December 2017 were enrolled, and according to the results of the 2-year follow-up, these patients were divided into recurrence group with 49 patients and non-recurrence group with 51 patients. Laboratory markers and MVI grade were compared between the two groups, and MVI grade, TNM stage, and BCLC stage were compared in terms of their value in predicting 2-year recurrence-free survival (RFS) after surgery. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of non-ranked data between two groups, and the Mann-Whitney U test was used for comparison of ranked data between groups; the Kruskal-Wallis H test was used for comparison between three groups, and the Bonferroni method was used for further comparison between two groups. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used for survival analysis. The consistency index calculated by RMS package was used to compare the predictive value of clinicopathological staging systems. Results Compared with the non-recurrence group, the recurrence group had significantly higher alpha-fetoprotein level (Z=0.099, P<0.05) and proportion of patients with MVI (Z=-2.651, P=0.008). After 2 years of follow-up, there were 47 patients in M0 group, 34 in M1 group, and 19 in M2 group; 18 patients in the M0 group (38.3%), 16 in the M1 group (47.1%), and 15 in the M2 group (78.9%) experienced recurrence, and there was a significant difference in recurrence between the three groups (H=8.934, P=0.011); further comparison between two groups showed that the M2 group had a significantly higher number of patients with recurrence than the M0 group and the M1 group (P<0.05). The cumulative recurrence rate was 41.9% in the M0+M1 group and 78.9% in the M2 group, and there was a significant difference between these two groups (χ2=11.445, P<0.001); the M2 group had a significantly lower 2-year RFS rate than the M0+M1 group. As for BCLC stage, the cumulative recurrence rate was 36.2% in the patients with early-stage (stage 0+stage 1) HCC and 66.7% in those with middle-and late-stage (stage 2+stage 3) HCC, and there was a significant difference between the two groups (χ2=5.047, P=0.012); the middle- and late-stage group had a significantly lower 2-year RFS rate than the early-stage group. As for TNM stage, the cumulative recurrence rate was 24.5% in the patients with stage Ⅰ HCC and 72.5% in those with stage Ⅱ+Ⅲ HCC, and there was a significant difference between the two groups (χ2=17.223, P<0.001); the stage Ⅱ+Ⅲ group had a significantly lower 2-year RFS rate than the stage I group. TNM stage had the highest value in predicting 2-year RFS, while MVI and BCLC stage had a similar predictive value (consistency index: 0.659 vs 0.598 vs 0.600). Conclusion Compared with MVI patients with no risk or low risk, patients with high-risk MVI have a significantly higher probability of early recurrence, and thus MVI may become an evaluation target for postoperative treatment.
【关键字】:癌,肝细胞; 微血管侵犯; 肿瘤分期; 肝切除术; 复发
【Key words】:carcinoma,hepatocellular; microvascular invasion; neoplasm staging; hepatectomy; recurrence
【引证本文】:HE XH, AN WH, ZENG QB, et al. Value of microvascular invasion grade in predicting the early recurrence of hepatocellular carcinoma after radical hepatectomy[J]. J Clin Hepatol, 2020, 36(8): 1757-1762. (in Chinese)
何旭昶, 安文慧, 曾庆彬, 等. 微血管侵犯分级对肝细胞癌行根治性肝切除术后早期复发的预测价值[J]. 临床肝胆病杂志, 2020, 36(8): 1757-1762.

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