本文選題：甲胎蛋白　切入點(diǎn)：肝細(xì)胞癌　出處：《寧夏醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 通過(guò)對(duì)比甲胎蛋白陰性肝細(xì)胞癌和甲胎蛋白陽(yáng)性肝細(xì)胞癌的病例資料,分析甲胎蛋白陰性肝細(xì)胞癌的臨床病理特征、預(yù)后及影響預(yù)后的因素。材料 與方法收集2010年1月~2016年1月在寧夏醫(yī)科大學(xué)總醫(yī)院肝膽外科住院行根治性手術(shù)治療且經(jīng)病理確診為肝細(xì)胞癌的194例患者的臨床資料。根據(jù)術(shù)前AFP水平分為AFP陰性及AFP陽(yáng)性兩組。對(duì)比兩組患者的一般資料、術(shù)前檢驗(yàn)資料、乙肝背景、術(shù)中情況及術(shù)后病理的不同。對(duì)兩組患者進(jìn)行隨訪,對(duì)比1年、3年、5年生存率的差異,多因素分析影響AFP陰性肝細(xì)胞癌患者預(yù)后的因素。結(jié)果 1、AFP陰性肝細(xì)胞癌與AFP陽(yáng)性肝細(xì)胞癌在性別、年齡、民族、住院時(shí)間、臨床癥狀、術(shù)前ALT、AST、GGT、HBV-DNA定量、衛(wèi)星灶、包膜是否完整方面均無(wú)顯著性差異(P0.05)。2、AFP陰性肝細(xì)胞癌與AFP陽(yáng)性肝細(xì)胞癌兩組在HbsAg、肝硬化、腫瘤大小、脈管癌栓、腫瘤病理分化程度方面具有顯著差異(P0.05)。3、總體的1年、3年、5年生存率為77%、62%、48%;AFP陰性組的1年、3年、5年生存率為93%、78%、67%;AFP陽(yáng)性組的1年、3年、5年生存率為69%、54%、39%,兩組使用Log-Rank單因素分析法,得出兩組在生存時(shí)間上有顯著性差異(P=0.002)。單因素分析顯示腫瘤分化程度及脈管癌栓與AFP陰性肝細(xì)胞癌預(yù)后有關(guān),多因素分析顯示腫瘤分化程度、脈管癌栓不是影響預(yù)后的獨(dú)立危險(xiǎn)因素。結(jié)論:1、AFP水平與性別、年齡、民族、住院時(shí)間、臨床癥狀、術(shù)前ALT、AST、GGT、HBV-DNA定量、衛(wèi)星灶、腫瘤包膜均無(wú)關(guān)。2、AFP水平與HbsAg、肝硬化、脈管癌栓、腫瘤體積大小及組織分化程度有關(guān)。3、AFP陰性肝細(xì)胞癌患者預(yù)后好。
[Abstract]:Objective to analyze the clinicopathological features of alpha-fetoprotein negative hepatocellular carcinoma (AFP) and alpha-fetoprotein positive hepatocellular carcinoma (AFP). Materials and methods from January 2010 to January 2016, 194 patients with hepatocellular carcinoma were treated by radical operation and pathologically diagnosed as hepatocellular carcinoma, from January 2010 to January 2016 in the Department of Hepatobiliary surgery, General Hospital of Ningxia Medical University. Data. According to preoperative AFP level, the patients were divided into two groups: AFP negative group and AFP positive group. The general data of the two groups were compared. The data of preoperative examination, background of hepatitis B, intraoperative condition and postoperative pathology were different. The difference of 1-year, 3-year, 5-year survival rate was compared between the two groups. Multivariate analysis of the prognostic factors of patients with AFP negative hepatocellular carcinoma. Results 1AFP negative hepatocellular carcinoma and AFP positive hepatocellular carcinoma in sex, age, nationality, length of stay, clinical symptoms, preoperative alt ASTT GGTHBV-DNA quantitative, satellite focus. There was no significant difference in whether the capsule was intact or not. There was no significant difference between the two groups in HbsAg, liver cirrhosis, tumor size, vascular tumor thrombus, and AFP positive HCC. There were significant differences in the degree of pathological differentiation between the two groups (P < 0.05). The overall survival rates for 1, 3 and 5 years were 1 year, 3 years and 5 years survival rate of 77% 6222 and 48% AFP negative group respectively. The 5 year survival rate was 93,3 years and 5 years survival rate of 93,3 and 5 years in the AFP-positive group respectively. The Log-Rank single factor analysis was used in the two groups. The results showed that there was significant difference in survival time between the two groups. Univariate analysis showed that the degree of tumor differentiation and vascular tumor embolus were related to the prognosis of AFP negative hepatocellular carcinoma, and multivariate analysis showed the degree of tumor differentiation. Conclusion the level of AFP and sex, age, nationality, length of stay, clinical symptoms, preoperative alt ASTT GGTT HBV-DNA quantitative analysis, satellite focus, tumor capsule were not associated with HBsAg, cirrhosis, vascular tumor thrombus. The size of tumor and the degree of tissue differentiation were related to the prognosis of HCC patients with AFP negative.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.7

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