本文選題：肥胖 + 肝細(xì)胞肝癌　； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:本研究旨在系統(tǒng)分析肥胖是否作為一種獨(dú)立的危險因素影響肝癌患者手術(shù)后的預(yù)后,包括近期并發(fā)癥、無瘤生存時間、總生存時間及生存率。進(jìn)一步探討分析合理減肥在降低肝癌的發(fā)生,延緩肝癌的進(jìn)展以及改善肝癌的預(yù)后等方面的作用與意義。方法:回顧性分析吉林大學(xué)中日聯(lián)誼醫(yī)院肝膽胰外科2010年1月至2014年12月間118例行根治性手術(shù)切除的肝癌患者的臨床資料。根據(jù)體重指數(shù)(body mass index,BMI),將研究對象分為肥胖和非肥胖兩組。肥胖組共41例,其中男性32例,女性9例;非肥胖組共77例,其中男性62例,女性15例。將兩組肝癌患者的一般因素及術(shù)后資料分別進(jìn)行T檢驗、卡方檢驗或Mann-Whitney U檢驗,繪制Kaplan-Meier生存曲線,進(jìn)行Log-Rank檢驗。對比分析兩組患者術(shù)后并發(fā)癥的發(fā)生率、無瘤生存時間、總生存時間、無瘤生存率及總生存率并進(jìn)行統(tǒng)計學(xué)分析。結(jié)果:肥胖組與非肥胖組相比,術(shù)后并發(fā)癥的發(fā)生率分別是17.1%vs20.8%(p0.05);術(shù)后平均無瘤生存時間分別是16.01個月vs 25.49個月(p0.05);中位無瘤生存時間分別為9個月vs 24個月(p0.05);術(shù)后總生存時間分別為28.27±17.91個月vs 36.37±19.30個月(p0.05);中位生存時間分別為26個月vs 37個月(p0.05);術(shù)后1、2、3、4、5年無瘤生存率,肥胖組與非肥胖組相比較分別為:34.1%vs 66.2%(p0.05),24.4%vs 51.9%(p0.05),22.6%vs 31.7%(p0.05),19.2%vs 30.2%(p0.05),16.7%vs 28.6%(p0.05);術(shù)后1~5年總生存率肥胖組與非肥胖組比較分別為:82.9%vs 89.6%(p0.05),58.5%vs 77.9%(p0.05),32.3%vs 65.1%(p0.05),26.9%vs 53.5%(p0.05),25.0%vs 42.9%(p0.05)。肥胖組的術(shù)后無瘤生存時間、總生存時間、1~2年無瘤生存率及2~4年總生存率明顯低于非肥胖組(P0.05),有統(tǒng)計學(xué)意義,而兩組之間的術(shù)后并發(fā)癥發(fā)生率、3~5年無瘤生存率及1年、5年總生存率無明顯統(tǒng)計學(xué)差異(P0.05)。而兩組的Kaplan-Meier生存曲線,經(jīng)過Log Rank檢驗,P0.05,統(tǒng)計學(xué)差異顯著。單因素分析結(jié)果顯示:腫瘤大小、腫瘤數(shù)量、AFP、分化分級、微血管侵犯及BMI影響患者手術(shù)切除后的復(fù)發(fā);腫瘤大小、腫瘤數(shù)量、分化分級、微血管侵犯及BMI影響患者術(shù)后的生存。Cox多因素分析顯示:腫瘤分化分級、微血管侵犯及BMI是肝癌患者手術(shù)切除后復(fù)發(fā)的獨(dú)立危險因素,而腫瘤大小、腫瘤數(shù)量、微血管侵犯及BMI是生存的獨(dú)立危險因素。結(jié)論:肥胖患者肝癌術(shù)后的無瘤生存時間、總生存時間、無瘤生存率及總生存率均明顯低于非肥胖患者。說明,肥胖可促進(jìn)肝癌的發(fā)展,縮短肝癌術(shù)后的無瘤生存時間及總生存時間,是影響肝癌預(yù)后的獨(dú)立危險因素。
[Abstract]:Objective: to systematically analyze whether obesity is an independent risk factor affecting the prognosis of patients with liver cancer, including recent complications, tumor-free survival time, total survival time and survival rate. To further explore the role and significance of reasonable weight loss in reducing the occurrence of liver cancer, delaying the progress of liver cancer and improving the prognosis of liver cancer. Methods: the clinical data of 118 patients with hepatobiliary and pancreatic cancer underwent radical resection from January 2010 to December 2014 were analyzed retrospectively. The subjects were divided into obese group and non obese group according to body mass index (BMI). There were 41 cases in obesity group, 32 cases in male and 9 cases in female, and 77 cases in non-obesity group, among which 62 cases were male and 15 cases were female. The general factors and postoperative data of the two groups of patients with liver cancer were examined by T test, chi-square test or Mann-Whitney U test, Kaplan-Meier survival curve was drawn and Log-Rank test was performed. The incidence of postoperative complications, tumor-free survival time, total survival time, tumor-free survival rate and overall survival rate were analyzed statistically. Results: the obese group compared with the non-obese group, The incidences of postoperative complications were 17.1vs20.8 and 16.01 months vs 25.49 months respectively, the median survival time was 9 months vs 24 months, and the total survival time was 28.27 鹵17.91 months vs 36.37 鹵19.30 months, respectively. The median survival time was 26 months vs 37 months, respectively. 鑲ヨ儢緇勪笌闈炶偉鑳栫粍鐩告瘮杈冨垎鍒負(fù):34.1%vs 66.2%(p0.05),24.4%vs 51.9%(p0.05),22.6%vs 31.7%(p0.05),19.2%vs 30.2%(p0.05),16.7%vs 28.6%(p0.05);鏈悗1~5騫存，

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