鲍乐 李鹏飞 王友彬 陈龙 梁爽

[摘要] 目的 考察晚期肝癌經导管肝动脉化疗栓塞术（TACE）术后再次复发的风险因素分析。 方法 选取2017年6月至2019年12月在我院经TACE术治疗的晚期肝癌患者50例作为研究对象，术后随访6个月。根据是否再次复发肝癌进行分组，比较未复发组与复发组患者的一般临床资料及临床病理特征，并采用Logistic多因素分析晚期肝癌患者TACE术后再次复发的危险因素。 结果 复发组AFP>400 ng/mL百分率及AST水平均显著高于未复发组，白蛋白>35 g/L百分率显著低于未复发组（P<0.05）;复发组肿瘤分化程度（低中分化）、肿瘤直径（>5 cm）、肿瘤病灶数量（多发）、门脉癌栓及包膜不完整百分率均显著高于未复发组（P<0.05）;Logistic多因素分析结果显示，肿瘤分化程度（OR=1.485，95%CI：1.098～3.740）、包膜不完整（OR=1.275，95%CI：0.784～1.648）、白蛋白>35 g/L（OR=2.672，95%CI：1.431～4.529）及AFP>400 ng/mL（OR=1.349，95%CI：0.983～1.957）是晚期肝癌患者TACE术后再次复发的危险因素（P<0.05）。 结论 肿瘤分化程度、包膜不完整、白蛋白>35 g/L及AFP>400 ng/mL是晚期肝癌患者TACE术后再次复发的危险因素。

[关键词] 晚期肝癌;经导管肝动脉化疗栓塞术;风险因素;再次复发

[中图分类号] R273          [文献标识码] B          [文章编号] 1673-9701（2021）34-0001-03

[Abstract] Objective To investigate the risk factors for the recurrence of advanced liver cancer after transcatheter arterial chemoembolization（TACE）. Methods A total of 50 patients with advanced liver cancer who were treated with TACE surgery in our hospital from June 2017 to December 2019 were selected as the study subjects， and they were followed up for 6 months after surgery. According to whether there was recurrence of liver cancer， the patients were grouped. The general clinical data and clinicopathological characteristics of patients were compared between the non-recurrence group and the recurrence group. Logistic multivariate analysis was used to analyze the risk factors of recurrence in the patients with advanced liver cancer after TACE. Results The AFP>400 ng/mL， percentage and AST level in the recurrence group were significantly higher than those in the non-recurrence group. The percentage of albumin>35 g/L was significantly lower than that in the non-recurrence group（P<0.05）; the degree of tumor differentiation （low-to-medium differentiation），tumor diameter（>5 cm）， number of tumor lesions （multiple）， portal vein tumor thrombus and the percentage of incomplete capsule in the recurrence group were significantly higher than those in the non-recurrence group（P<0.05）; Logistic multivariate analysis showed the degree of tumor differentiation （OR=1.485，95%CI：1.098-3.740）， incomplete capsules（OR=1.275，95%CI：0.784-1.648），albumin>35 g/L（OR=2.672，95%CI：1.431-4.529）and AFP>400 ng/mL （OR=1.349， 95%CI：0.983-1.957） were risk factors for recurrence after TACE in the patients with advanced liver cancer（P<0.05）. Conclusion The degree of tumor differentiation， incomplete capsules， albumin>35 g/L and AFP>400 ng/mL were risk factors for recurrence after TACE in the patients with advanced liver cancer.

[Key words] Advanced liver cancer; Transcatheter arterial chemoembolization; Risk factors; Recurrence

原发性肝癌（Primary liver cancer，PLC）是一种高度致命的恶性肿瘤，早期无明显症状，伴随疾病进展可出现食欲下降、消化不良、肝区疼痛、发热等症状[1-2]。外科手术是PLC患者最主要治疗手段，但仅有20%的患者可采用外科手术切除治疗，约有70%以上的患者确诊时已为中晚期，缺乏手术指征[3]。经导管肝动脉化疗栓塞术（Transcatheter arterial chemoembolization，TACE）治疗原发性肝癌的机制主要是基于肝癌与肝脏的血供特点，相比于全身化疗，具有作用时间长、效果显著和副作用低等优势。然而临床研究发现肝癌患者肿瘤细胞周围微环境和肝脏血供变化均会导致肝癌的转移和复发[4]，因而明确TACE术后复发的相关危险因素，对于肝癌患者及早干预、提高生活质量具有积极意义。基于此本研究考察……