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目的探讨肝细胞癌(肝癌)患者术前Plt在评价术后生存预后中的价值。方法回顾性研究1987年1月至1994年12月在中山大学肿瘤防治中心肝胆肿瘤外科行肝癌肝切除的399例患者临床资料。所有患者均签署知情同意书,符合医学伦理学规定。其中男356例,女43例;年龄21~78岁,中位年龄48岁。观察术前Plt与患者性别、年龄、GGT、HBsAg、AFP、肝硬化、肿瘤包膜、肿瘤直径、肿瘤数目、肿瘤血管侵犯、肿瘤组织学分化程度等临床病理学参数的关系。根据术前Plt将患者分为G1组(<100×109/L,41例)、G2组(100×109/L~300×109/L,321例)、G3组(>300×109/L,37例),对3组患者进行生存分析。术前Plt与临床病理学参数的关系比较采用t检验,生存分析采用Kaplan-Meier法和Log-rank检验,生存预后分析采用Cox比例风险回归模型分析。结果术前Plt与HBsAg、AFP、肿瘤直径有关(t=2.069,2.222,-3.911;P<0.05)。G1组患者5、10、15年累积生存率分别为41.2%、25.2%、11.8%,G2组分别为33.7%、23.0%、18.1%,G3组分别为11.4%、8.6%、5.7%。G3组患者生存率明显低于G1组和G2组(χ2=5.706,11.361;P<0.05)。术前Plt增多为患者术后生存预后的独立危险因素,G3组患者生存预后较G1组和G2组差(HR=1.761,1.845;P<0.05)。结论肝癌患者术前Plt增多为肝癌肝切除术后生存预后的独立危险因素,术前Plt增多的患者预后差。
Objective To investigate the value of preoperative Plt in evaluating the prognosis of patients with hepatocellular carcinoma (HCC). Methods The clinical data of 399 patients with hepatocellular carcinoma who underwent hepatectomy in hepatobiliary tumor from January 1987 to December 1994 in Sun Yat-sen University Cancer Center were retrospectively studied. All patients signed informed consent, in line with medical ethics rules. There were 356 males and 43 females, ranging in age from 21 to 78 years, with a median age of 48 years. The relationship between preoperative Plt and clinicopathological parameters such as gender, age, GGT, HBsAg, AFP, cirrhosis, tumor capsule, tumor diameter, tumor number, tumor vessel invasion and tumor histological differentiation were observed. The patients were divided into G1 group (<100 × 109 / L, 41 cases), G2 group (100 × 109 / L ~ 300 × 109 / L, 321 cases) and G3 group (> 300 × 109 / L , 37 cases), 3 groups of patients for survival analysis. Preoperative Plt and clinicopathological parameters were compared using t test, survival analysis using Kaplan-Meier method and Log-rank test, survival prognosis analysis using Cox proportional hazards regression model analysis. Results Preoperative Plt was associated with HBsAg, AFP and tumor diameter (t = 2.069,2.222, -3.911; P <0.05). The cumulative survival rates at 5, 10 and 15 years in G1 group were 41.2%, 25.2% and 11.8%, respectively, which were 33.7%, 23.0% and 18.1% in G2 group and 11.4%, 8.6% and 5.7% in G3 group respectively. The survival rate of patients in G3 group was significantly lower than those in G1 and G2 groups (χ2 = 5.706, 11.361; P <0.05). The preoperative Plt increase was an independent risk factor for postoperative survival and prognosis in patients with G3. The prognosis of patients in G3 group was worse than that in G1 and G2 (HR = 1.761,1.845; P <0.05). Conclusions The preoperative Plt increase in hepatocellular carcinoma is an independent risk factor for survival after hepatectomy. The preoperative Plt increase in patients with poor prognosis.