發(fā)布時間：2018-03-15 00:21

  本文選題：肝癌　切入點：肝細胞癌　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：肝癌是世界范圍內(nèi)最常見的惡性腫瘤之一,發(fā)病率較高,且預(yù)后不佳。肝癌早期多無明顯癥狀,因此很多患者就診時就已經(jīng)發(fā)展至肝癌晚期,失去最佳治療時機,進一步導(dǎo)致了不良的預(yù)后。此外,肝癌術(shù)后易早期復(fù)發(fā)轉(zhuǎn)移,是導(dǎo)致肝癌預(yù)后不佳的又一重要原因。影響肝癌預(yù)后的因素有很多,比如腫瘤大小、數(shù)量、分化程度、是否存在局部或遠處轉(zhuǎn)移等。越來越多的臨床觀察發(fā)現(xiàn),有些小肝癌患者,盡管腫瘤很小,但是病理檢查卻發(fā)現(xiàn)已經(jīng)伴有微血管侵犯,而有些大肝癌卻沒有檢測到微血管侵犯。由此看來肝癌的惡性度和預(yù)后可能并不與腫瘤大小絕對相關(guān),而是取決于是否有早期微血管侵犯。因此,近年來微血管侵犯對肝癌預(yù)后的影響受到極大關(guān)注,是判斷肝癌生物學(xué)行為、侵襲性和預(yù)后等方面研究的熱點。目的:本研究旨在通過回顧性分析我院行根治性切除的肝細胞癌患者的臨床資料,進一步分析微血管侵犯對肝細胞癌預(yù)后的影響,以明確微血管侵犯在肝癌發(fā)生發(fā)展中的意義和作用,以期進一步指導(dǎo)臨床肝癌的診治。資料與方法:收集我科2010年至2014年行肝癌根治性手術(shù),且術(shù)后病理證實為肝細胞癌的患者的臨床資料(病史、血清化驗結(jié)果、影像結(jié)果、在院治療情況以及隨訪復(fù)查資料),對其進行系統(tǒng)的回顧性分析,分為伴微血管侵犯與不伴微血管侵犯兩組,應(yīng)用Kaplan-Meier生存曲線分析對比兩組無瘤生存時間以及總體生存時間差異,結(jié)果采用Log-Rank方法檢驗。對肝硬化、腫瘤大小、數(shù)量、分化程度、年齡、肝炎感染史等危險因素進行單因素分析,分析其對肝癌預(yù)后的影響。結(jié)果:共收集病例118例,分為兩組,其中伴微血管侵犯組28例(23.7%),不伴微血管侵犯組90例(76.3%);男性94例(79.6%),女性24例(20.4%),年齡20-73歲,平均年齡54歲;乙型病毒性肝炎患者94例(79.6%),丙型病毒性肝炎患者16例(13.6%),無肝炎患者8例(6.8%);伴有肝硬化患者96例(81.3%),無肝硬化患者22例(18.7);腫瘤單發(fā)的患者97例(82.2%),腫瘤多發(fā)的患者21例(17.8%);微小肝癌(腫瘤小于2cm)的患者有22例(18.6%),小肝癌(腫瘤大于2cm小于等于5cm)的患者有53例(45%),大肝癌(腫瘤大于5cm小于等于10cm)的患者有33例(28.0%),巨大肝癌(腫瘤大于10cm)的患者有10例(8.4%);肝功能Child-Pugh分級A級110例(93.2%),B級8例(6.8%);甲胎蛋白(alpha-fetoprotein,AFP)小于20ul/L的患者55例(46.6%),大于20ul/L小于400ul/L的患者31例(26.3%),大于400ul/L的患者32例(27.1%);根據(jù)我院病理科對術(shù)后病理腫瘤的分化程度(ES分級)的描述分為2組,分別為I/II級:87例(73.7%),III/IV級:31例(26.3%);根據(jù)隨訪患者有無術(shù)后治療(抗病毒治療、再次手術(shù)、TACE、射頻消融、微波固化、無水酒精注射、抗腫瘤藥物等)分為兩組,有上述術(shù)后治療的47例(39.8%),無術(shù)后治療的患者71例(60.2%)。隨訪截止至2016年12月,伴微血管侵犯組平均存活時間為29.46±20.24個月,中位生存時間為29個月,最長存活時間為72個月,不伴微血管侵犯組的平均存活時間為37.89±19.10個月,中位生存時間為50個月,最長存活時間為78個月。伴微血管侵犯組平均無瘤生存時間為17.07±18.96個月,而不伴微血管侵犯組的平均無瘤生存時間為25.03±20.51個月。Kaplan-Meier曲線顯示1、3、5年累計生存率伴微血管侵犯組跟不伴微血管侵犯組相比分別為64%vs 86.7%,38%vs 68.7%,和25%vs 35.7%,統(tǒng)計學(xué)差異顯著。1、3、5年無瘤生存率伴微血管侵犯組跟不伴微血管侵犯組相比分別為42.8%vs 63.3%,20.8%vs 37.3%,和16.6%vs 25%,統(tǒng)計學(xué)差異顯著。結(jié)論:微血管侵犯是影響肝癌預(yù)后的重要危險因素。伴有微血管侵犯的肝細胞癌患者的1、3、5年總體生存時間及無瘤生存時間均明顯低于不伴微血管侵犯的患者。
[Abstract]:Liver cancer is one of the most common malignant tumors in the world, high incidence and poor prognosis. Early hepatocellular carcinoma without obvious symptoms, so many patients have developed to liver cancer, lose the best timing of treatment, further leads to poor prognosis. In addition, early recurrence and metastasis after liver resection is caused easily, and one important reason for poor prognosis for HCC. There are many factors affecting the prognosis of liver cancer, such as tumor size, number, degree of differentiation, the existence of local or distant metastasis. More and more clinical observation found that some small liver cancer patients, although the tumor is small, but the pathological examination found already associated with microvascular invasion, and some large hepatocellular carcinoma was not detected. Thus the microvascular invasion of malignant degree and prognosis of HCC may not be absolutely related with tumor size, but depends on whether the early microvascular invasion. This, in recent years the effect of microvascular invasion on the prognosis of liver cancer is of great concern, judging the biological behavior of HCC, the research hotspot in the field of invasiveness and prognosis. Objective: the purpose of this study is to through retrospective analysis of clinical data in our hospital underwent radical resection of hepatocellular carcinoma patients, further analyze the influence on the prognosis of liver cells cancer microvascular invasion, in order to clear the microvascular invasion on the significance and role in the development of hepatocellular carcinoma, diagnosis and treatment of liver cancer in order to guide the clinical treatment. Materials and methods: from 2010 to 2014 for liver cancer radical surgery, and postoperative pathology confirmed the clinical data of patients with hepatocellular carcinoma (the history of results the imaging results, serum tests, in the hospital treatment and follow-up data), retrospective analysis was performed on the system, divided into patients with microvascular invasion and without microvascular invasion in two groups, with Kaplan-Meier 瀛樻洸綰垮垎鏋愬姣斾袱緇勬棤鐦ょ敓瀛樻椂闂翠互鍙婃，

本文編號：1613604