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目的通过探索肝癌术后长期生存的因素,为临床治疗、预后判断提供足够依据。方法对37例术后生存>20年的肝细胞癌(A组)和35例同期术后生存≤3年死亡的患者(B组)进行临床病理特征和p53、c-myc表达特点的比较分析。结果 A组患者大部分67.6%来自于普查,肿瘤切缘>1cm,术后1个月AFP转阴率为96.8%,极显著优于B组的相应结果 (P<0.01);在临床症状上,有/无肝炎史、有/无肝炎家族史方面两组差异不显著(P>0.05)。癌旁肝组织中,两组p53阳性率分别为24.3%和71.4%;c-myc阳性率分别为37.8%和80%,两组比较差异极显著(P<0.01)。结论普查发现的患者、单个肿瘤直径≤5cm、有完整包膜、无癌栓、组织学分级Ⅰ～Ⅱ级和癌周无硬化或轻度硬化是肝癌患者长期生存的重要因素,p53和c-myc基因在癌旁肝组织中的表达与预后呈明显负相关。
Objective To explore the long-term postoperative survival of liver cancer factors, to provide adequate evidence for clinical treatment, prognosis. Methods The clinical and pathological features and the expression of p53 and c-myc in 37 patients with hepatocellular carcinoma (group A) who survived for more than 20 years and 35 patients who died after 3-year survival (group B) . Results Most of 67.6% patients in group A came from the census and the tumor margin was> 1cm. The negative rate of AFP in one month after operation was 96.8%, which was significantly better than the corresponding results in group B (P <0.01) , With / without history of hepatitis, family history of / without hepatitis, there was no significant difference between the two groups (P> 0.05). The positive rates of p53 in the two groups were 24.3% and 71.4%, respectively. The positive rates of c-myc were 37.8% and 80%, respectively, which were significantly different between the two groups (P <0.01). CONCLUSIONS: A single tumor with a diameter of ≤5 cm, a complete envelopment without tumor thrombus, histological grade Ⅰ ~ Ⅱ and non-sclerosis or mild sclerosis of peri-cancerous tissue are important factors in the long-term survival of patients with liver cancer. The expression of p53 and c- The expression of myc gene in the adjacent noncancerous liver tissue has a negative correlation with the prognosis.