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摘要：
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摘要：目的 探讨影响原发性肝癌（primary liver cancer，PLC）患者肝切除术后早期和晚期复发及预后的
危险因素。方法 回顾性分析2014年10月至2018年10月河南大学人民医院收治的97例经病理证实为PLC且
行肝切除术患者的病例资料，随访2年以上，选择年龄、性别、TNM分期、肝硬化、血小板/淋巴细胞
（platelet to lymphocyte ratio，PLR）、甲胎蛋白（alpha fetoprotein，AFP）、病毒感染情况、Child-Pugh
分级、食管静脉曲张、脾静脉宽度、门静脉宽度、脾脏最大内径、肿瘤最大直径、癌结节数、TNM分
期、脉管癌栓、微血管浸润、肿瘤包膜是否完整、手术切缘宽度、肿瘤超越米兰标准及卫星结节19个
指标，采用单因素及多因素Logistic回归分析影响PLC患者肝切除术后早期和晚期复发的相关因素。结
果 97例患者中63例复发，复发率为64.95%（63/97），其中早期复发（≤ 24个月）34例，晚期复发（＞
24个月）29例。多因素Logistic回归分析表明，PLR ＜ 107、TNM分期Ⅲ/Ⅳ期、存在脉管癌栓、手术切
缘宽度 ≤ 1 cm及存在卫星结节是PLC患者肝切除术后早期复发的独立危险因素（均P ＜ 0.05）；肝硬化
则是晚期复发的唯一危险因素（OR = 1.487，95%CI：1.104～2.003，P = 0.0024）。结论 肝硬化、手术
切缘是否完整、是否存在脉管癌栓、TNM分期等指标可用于评估PLC患者肝切除术后肿瘤复发的危险
性，肝切除术后积极开展辅助治疗，对延长患者无瘤生存期具有一定的临床价值。
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Abstract: Objective To investigate the risk factors of early and late recurrence and prognosis of patients
with primary liver cancer (PLC) after hepatectomy. Methods A retrospective analysis of 97 patients with
PLC after hepatectomy confirmed by pathology in People’s Hospital of Henan University from October 2014
to October 2018 were followed up for more than 2 years. Age, gender, TNM stage, liver cirrhosis, platelet
to lymphocyte ratio (PLR), alpha fetoprotein (AFP), viral infection, Child-Pugh classification, esophageal
varices, splenic vein width, portal vein width, spleen length, maximum tumor diameter, number of cancer
nodules, TNM stage, vascular tumor thrombus, microvascular infiltration, tumor capsule integrity, surgical
margin width, tumor beyond Milan standard and satellite nodule were selected as indicators. Univariate and
multivariate Logistic regression analysis was used to analyze the related factors of recurrence after surgical
resection of patients with PLC. Results Out of the 97 patients, 63 had recurrence, with a recurrence rate of
64.95% (63/97), of which 34 had early recurrence (≤ 24 months) and 29 had late recurrence (＞ 24 months).
Multivariate Logistic regression analysis showed that platelet/lymphocyte ratio (PLR) < 107, TNM (Ⅲ/Ⅳ),
presence of vascular cancer thrombus and surgical margin ＜ 1 cm were independent risk factors for early
recurrence of patients with PLC after hepatectomy (all P ＜ 0.05). Liver cirrhosis was the only risk factor for
late recurrence (OR = 1.487, 95%CI: 1.104～2.003, P = 0.0024). Conclusions The indexes of liver cirrhosis,
integrity of surgical margin, existence of vascular tumor thrombus and the degree of differentiation of liver
cancer cells can be used to evaluate the risk of recurrence in patients with PLC and actively carry out adjuvant
therapy after hepatectomy. It has certain clinical value to prolong the tumor-free survival time.
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