肝细胞性肝癌合并门静脉癌栓与甲胎蛋白的高危因素分析

Analysis of high risk factors for hepatocellular carcinoma combined with portal vein tumor thrombus and alpha-fetoprotein

摘要:

目的：探讨肝细胞性肝癌（hepatic carcinoma，HCC），以下简称肝癌，患者发生门静脉癌栓（portal vein tumor thrombus，PVTT）的高危因素。方法：通过回顾性分析随机抽取的本科室2009年4月至2011年4月收治的HCC患者126例。分析 PVTT形成高危因素，包括甲胎蛋白（alpha-fetoprotein，AFP）值（以400 ng/ml为界）、有无 PVTT、HBsAg、肿瘤直径、肿瘤数目、细胞分化程度（Edmondson-Steiner分级法）、有无脉管浸润以及性别。用卡方检验及非条件logistic回归分析。结果：126例为HCC，56例（44.4%）确诊为HCC合并PVTT。脉管浸润、肿瘤直径、高滴度AFP、肿瘤数目、细胞分化程度为 PVTT形成的高危因素（ χ2=20.97、13.67、4.73、5.04，均P＜0.05）。肿瘤大小、脉管浸润、细胞分化程度与AFP有关系（ χ2=8.121、4.038，均P＜0.05）。多因素分析AFP、脉管浸润是PVTT发生的独立危险因素。结论：在 HCC患者中，高滴度血清AFP可成为HCC患者发生 PVTT的一项危险指标，对早期发现肝癌合并 PVTT具有临床指导意义。

Abstract:

Objective：To investigate the risk factors for hepatocellular carcinoma（HCC） combined with portal vein tumor thrombus（PVTT）. Methods：Retrospective analysis was conducted for 126 HCC patients chosen at random in the department of hepatobiliary surgery in the First Affiliated Hospital of Chongqing Medical Uni－versity from April 2009 to April 2011. Alpha-fetoprotein（AFP） level（400 ng/ml is the dividing line），with or without the PVTT，tumor size，cell differentiation grade（Edmondson-Steiner grade），tumor number，gender and vascular invasion were observed. Chi-square test and non-conditional logistic regression analysis were adopted to do statistical analysis. Results：Totally 126 patients were diagnosed as HCC including 56 HCC patients combined with PVTT（44.4%）. Vascular invasion，tumor size，high level of AFP，cell differentiation grade，tumor number were the risk factors for PVTT formation（χ2=20.97，13.67，4.73，5.04，all P<0.05）. Vascular invasion，tumor size，cell differentiation grade were the risk factors for AFP（χ2=8.121，4.038，all P＜0.05）. AFP and vascular invasion were the independent risk factors for PVTT. Conclusion：High leveled AFP could become one risk factor for HCC patients combined with PVTT，which can help to find or treat PVTT at early stage.