• 復(fù)旦大學(xué)肝癌研究所、復(fù)旦大學(xué)附屬中山醫(yī)院肝臟外科（上海200032）;;
  • 通訊作者： 孫惠川;

目的 　研究肝癌患者血清HBeAg狀態(tài)對(duì)肝癌切除術(shù)后復(fù)發(fā)及生存的影響。
方法 　收集1999~2005年在我科行根治性切除的223例腫瘤直徑≤3 cm的肝癌患者的資料。根據(jù)患者術(shù)前血清HBeAg狀態(tài)，分為HBeAg陽(yáng)性組（n=73）和HBeAg陰性組（n=150），比較2組患者無(wú)瘤生存率（DFS）和總體生存率（OS），并分析影響DFS和OS的危險(xiǎn)因素。
結(jié)果 　HBeAg陽(yáng)性和HBeAg陰性患者的1、3、5年的OS分別為91.5%、76.8%、60.1%和95.2%、85.3%、73.2%（P=0.053）； 1、3、5年DFS分別為73.3%、53.7%、40.3%和86.6%、65.5%、54.5%（P=0.002）。與HBeAg陰性組比較，HBeAg陽(yáng)性組患者年齡較輕（P=0.004），肝硬變較重（P=0.008），而在腫瘤因素及手術(shù)相關(guān)因素方面2組間的差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）。對(duì)DFS和OS的多因素分析顯示，年齡＞50歲、HBeAg陽(yáng)性和大結(jié)節(jié)肝硬變是影響OS的獨(dú)立危險(xiǎn)因素，而HBeAg陽(yáng)性和多發(fā)腫瘤是影響DFS的獨(dú)立危險(xiǎn)因素。
結(jié)論 　小肝癌患者術(shù)后HBeAg陽(yáng)性患者較HBeAg陰性者更易早期復(fù)發(fā)，而且總體生存較差。

引用本文： 孫惠川,張偉,欽倫秀,葉青海,王魯,任寧,莊鵬遠(yuǎn),朱小東,陸錄,錢永兵,郭家愷,項(xiàng)世駿,張瑋德,樊嘉,湯釗猷. 血清HBeAg狀態(tài)對(duì)肝細(xì)胞癌患者術(shù)后生存的影響. 中國(guó)普外基礎(chǔ)與臨床雜志, 2007, 14(1): 32-38. doi: 復(fù)制

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  1. 1. 　Tang ZY, Yu YQ, Zhou XD, et al. Progress and prospects in hepatocellular carcinoma surgery [J]. Ann Chir， 1998; 52(6)∶558.
  2. 2. 　Tang ZY, Ye SL, Liu YK, et al. A decade’s studies on metastasis of hepatocellular carcinoma [J]. J Cancer Res Clin Oncol， 2004; 130(4)∶187.
  3. 3. 　Poon RT, Ng IO, Lau C, et al. Correlation of serum basic fibroblast growth factor levels with clinicopathologic features and postoperative recurrence in hepatocellular carcinoma [J]. Am J Surg， 2001; 182(3)∶298.
  4. 4. 　Dusheiko G. Candidates for therapy: HBV [J]. J Hepatol， 2006; 44(1 Suppl)∶S84.
  5. 5. 　Chen CJ, Yang HI, Su J, et al. Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level [J]. JAMA， 2006; 295(1)∶65.
  6. 6. 　Colombo M, Donato MF. Prevention of hepatocellular carcinoma [J]. Semin Liver Dis， 2005; 25(2)∶155.
  7. 7. 　Hanazaki K, Kajikawa S, Shimozawa N, et al. Survival and recurrence after hepatic resection of 386 consecutive patients with hepatocellular carcinoma [J]. J Am Coll Surg， 2000; 191(4)∶381.
  8. 8. 　Grazi GL, Cescon M, Ravaioli M, et al. Liver resection for he-patocellular carcinoma in cirrhotics and noncirrhotics. Evaluation of clinicopathologic features and comparison of risk factors for long-term survival and tumour recurrence in a single centre [J]. Aliment Pharmacol Ther， 2003; 17 Suppl 2∶119.
  9. 9. 　Peng SY, Chen WJ, Lai PL, et al. High alpha-fetoprotein level correlates with high stage, early recurrence and poor prognosis of hepatocellular carcinoma: significance of hepatitis virus infection, age, p53 and beta-catenin mutations [J]. Int J Cancer， 2004; 112(1)∶44.
  10. 10. 　Hanazaki K, Matsushita A, Nakagawa K, et al. Risk factors of intrahepatic recurrence after curative resection of hepatocellular carcinoma [J]. Hepatogastroenterology， 2005; 52(62)∶580.
  11. 11. 　Adachi E, Maehara S, Tsujita E, et al. Clinicopathologic risk factors for recurrence after a curative hepatic resection for hepatocellular carcinoma [J]. Surgery， 2002; 131(1 Suppl)∶S148.
  12. 12. 　Poon RT, Fan ST, Ng IO, et al. Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma [J]. Cancer， 2000; 89(3)∶500.
  13. 13. 　Yang HI, Lu SN, Liaw YF, et al. Hepatitis B e antigen and the risk of hepatocellular carcinoma [J]. N Engl J Med， 2002; 347(3)∶168.
  14. 14. 　Kubo S, Hirohashi K, Yamazaki O, et al. Effect of the presence of hepatitis B e antigen on prognosis after liver resection for hepatocellular carcinoma in patients with chronic hepatitis B [J]. World J Surg， 2002; 26(5)∶555.
  15. 15. 　Kubo S, Hirohashi K, Tanaka H, et al. Effect of viral status on recurrence after liver resection for patients with hepatitis B virus-related hepatocellular carcinoma [J]. Cancer， 2000; 88(5)∶1016.
  16. 16. 　Chen JH, Chau GY, Lui WY, et al. Surgical results in patients with hepatitis B-related hepatocellular carcinoma and positive hepatitis B early antigen [J]. World J Surg， 2000; 24(3)∶383.
  17. 17. 　Sun HC, Tang ZY, Wang L, et al. Postoperative interferon alpha treatment postponed recurrence and improved overall survival in patients after curative resection of HBV-related hepatocellular carcinoma: a randomized clinical trial [J]. J Cancer Res Clin Oncol， 2006; 132(7)∶458.
  18. 18. 　Jiao LR, Habib NA. Randomized clinical trial of the effects of abdominal drainage after elective hepatectomy using the crushing clamp method (Br J Surg 2006; 93∶422-426) [J]. Br J Surg， 2006; 93(8)∶1024.
  19. 19. 　Couinaud C. The anatomy of the liver [J]. Ann Ital Chir, 1992; 63(6)∶693.
  20. 20. 　Edmondson HA， Steiner PE. Primary carcinoma of the liver: a study of 100 cases among 48 900 necropsies [J]. Cancer, 1954; 7(3)∶462.
  21. 21. 　Ohata K, Hamasaki K, Toriyama K, et al. High viral load is a risk factor for hepatocellular carcinoma in patients with chronic hepatitis B virus infection [J]. J Gastroenterol Hepatol， 2004; 19(6)∶670.
  22. 22. 　Capussotti L, Muratore A, Amisano M, et al. Liver resection for hepatocellular carcinoma on cirrhosis: analysis of mortality, morbidity and survival——a European single center experience [J]. Eur J Surg Oncol， 2005; 31(9)∶986.
  23. 23. 　Hanazaki K, Matsushita A, Nakagawa K, et al. Risk factors of long-term survival and recurrence after curative resection of hepatocellular carcinoma [J]. Hepatogastroenterology， 2005; 52(62)∶552.
  24. 24. 　Tung-Ping Poon R, Fan ST, Wong J. Risk factors, prevention, and management of postoperative recurrence after resection of hepatocellular carcinoma [J]. Ann Surg， 2000; 232(1)∶10.
  25. 25. 　Hanazaki K, Kajikawa S, Shimozawa N, et al. Perioperative blood transfusion and survival following curative hepatic resection for hepatocellular carcinoma [J]. Hepatogastroenterology， 2005; 52(62)∶524.
  26. 26. 　Nakanishi S, Michitaka K, Miyake T, et al. Decompensated hepatitis B virus-related cirrhosis successfully treated with lamivudine allowing surgery for hepatocellular carcinoma [J]. Intern Med， 2003; 42(5)∶416.
  27. 27. 　Nagamatsu H, Itano S, Nagaoka S, et al. Prophylactic lamivudine administration prevents exacerbation of liver damage in HBe antigen positive patients with hepatocellular carcinoma undergoing transhepatic arterial infusion chemotherapy [J]. Am J Gastroenterol， 2004; 99(12)∶2369.
  28. 28. 　Lai CL, Lim SG, Brown NA, et al. A dose-finding study of once-daily oral telbivudine in HBeAg-positive patients with chronic hepatitis B virus infection [J]. Hepatology， 2004; 40(3)∶719.
  29. 29. 　Kurihara T, Imazeki F, Yokosuka O, et al. Effect of lamivudine in HBeAg-positive chronic hepatitis B: discordant effect on HBeAg and HBV DNA according to pretreatment ALT level [J]. World J Gastroenterol， 2005; 11(22)∶3346.
  30. 30. 　Fujioka S. Case-control study of lamivudine treatment in patients with HBV-related hepatocellular carcinoma [J]. Hepatology, 2003; 38(4)∶719A.
  31. 31. 　Cheng SQ, Wu MC, Chen H, et al. Antiviral therapy using lamivudine and thymosin alpha(1) for hepatocellular carcinoma coexisting with chronic hepatitis B infection [J]. Hepato Gastroenterol, 2006; 53(68)∶249.