第七课：肝癌预后危险因素

clinicopathological factors Age

≤65

>65

Sex

M

F

Presentation

Subclinical

Symptomatic

Hepatitis B surface antigen

Positive

Negative

Hepatitis C antibody

Positive

Negative

Dual infection

Positive

Negative

Child classification

Grade A

Grade B

Preoperative ICG R-15 min (%)

≤15

>15

Serum Urea nitrogen (mg/dl)

≤21

>21

Serum Creatinine (mg/dl)

≤1.4

>1.4

Serum Albumin (g/dl)

≤3.5

>3.5

Serum Alkaline phosphatase (U/L)

≤94

>94

Serum Aspartate aminotransferase (U/L)

≤34

>34

Serum Alanine aminotransferase (U/L)

≤36

Serum Total bilirubin (mg/dl)

≤2.0

>2.0

Platelet count (≤109/L)

≤150

>150

Prothrombin time/prolong (s)

≤4.0

>4.0

Extent of resection（Type of resection）

Major hepatectomy

Minor hepatectomy

Major resection is defined as resection of ≥three segments, minor resection as resection of ≤two segments.

Blood loss (L)

≤4

>4

Blood transfusion

No

Yes

Morbidity

No

Yes

AFP

≤20

>20

Rupture

No

Yes

Tumor size (cm)

≤2？5？

>2？5？

Satellite lesions

None

Yes

Resection margin (cm)

≤1

>1

Capsular formation

Positive

Negative

Capsular invasion

No

Vascular invasion

No

Yes

Diploidy status

Yes

No

Tumor number

Solitary

Multiple

Macroscopic resection margin

≤1 cm

＞1 cm

Microscopic resection margin

Positive

Negative

Microscopic venous invasion

No

Yes

Tumor encapsulation

No

Yes

pTNM stage≈

I

II

IIIA

IVA

Abbreviation: pTNM stage, pathologic tumor-node-metastasis stage. 1

对于乙肝患者而言，术前HBV-DNA水平的影响很重要！

此外，肝硬化、肝纤维化程度的影响！

The following clinicopathologic variables that might correlate with disease-free survival and recurrence rates were evaluated: 2

presence of HBsAg marker,

presence of anti-HCV antibodies,

Child classification,

[alpha]-fetoprotein level,

diameter of nodules (<5 cm vs. >5 cm),

number of nodules (single vs. multiple),

preoperative intra-arterial chemoembolization,

type of resection,

intraoperative blood transfusion,

micro- or macroscopic portal vein infiltration,

presence of tumor capsule,

preoperative aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels

HBsAg positive 32 (14.3%) 16% 77% NS

HBsAg negative 192 (85.7%) 37% 51%

HCV positive 129 (57.6%) 45% 59% NS

HCV negative 36 (16.1%) 14% 48%

Alpha-fetoprotein _20 ng/mL 110 (49%) 27% 45% NS

Alpha-fetoprotein _20 ng/mL 114 (51%) 44% 61%

Child A 185 (82.6%) 36% 59% NS

Child B _ C 39 (17.4%) 30% 36%

Single nodule 200 (89.1%) 32% 52% _.01

Multiple nodule 24 (10.9%) 67% 100%

Tumor diameter _5 cm 181 (81%) 33% 56% NS

Tumor diameter _5 cm 43 (19%) 39% 39%

Intraop. blood transfusion 71 (31.7%) 42% 58% NS

No intraop. blood transfusion 153 (68.3%) 31% 52%

Presence of tumor capsule 81 (36%) 20% 50% _.05

Absence of tumor capsule 143 (64%) 43% 60%

Microvascular portal invasion 105 (46.9%) 44% 61% _.05

No microvascular portal invasion 119 (53.1%) 24% 50%

Preop. TACE 98 (43.8%) 37.4% 60.5% NS

No preop. TACE 126 (56.2%) 36.7% 56.7%

Wedge resection 67 (29.9%) 33.1% 53.2% NS

Segmentectomy (1–2 segments) 135 (60.3%) 35% 55.2%

Hepatectomy (_2 segments) 22 (9.8%) 33.4% 56.3%

AST _80 U/L 157 (70.1%) 24% 46% _.001

AST _80 U/L 67 (29.9%) 60% 74%

ALT _80 U/L 131 (58.5%) 26% 50% NS

ALT _80 U/L 93 (41.5%) 46% 61%

In the present series, disease-free survival was significantly longer in patients with single nodules, complete tumor capsule, no portal vein infiltration, and low aminotransferase levels.

The following were analyzed: twelve clinical factors (sex, age ≤ or ＞60 years, subclinical or symptomatic presentation, Child’s grade A or B, serum bilirubin level ≤ or ＞20 mmol/L, serum albumin level ≤ or ＞35 g/L, platelet count ≤or ＞100×109 platelets/L, prothrombin time ≤ or . 12.5 seconds, serum AST level ≤ or . 100 IU/L, serum ALT level ≤or . 100 IU/L, ICG R-15 ≤or . 14%, and serum alpha-fetoprotein level ≤ or . 20 ng/mL), five operative or treatment factors (major or minor resection, blood loss ≤ or . 1.5 L, perioperative transfusion, preoperative