美国外科权威杂志Surgery在线发表了山东大学齐鲁医院普外科李涛副主任医师的关于女性肝癌患者手术治疗及预后分析的文章。由于雌激素的保护作用，女性患乙肝及肝癌的风险较男性低，但是近年来随着女性生活习惯的改变，女性患肝癌的比例增加并且预后也较差。此研究系统探索了手术切除的459例女性肝癌患者的临床病理特点，分析年龄及雌激素水平对手术切除后的预后及复发的危险因子的影响，发现尽管女性肝癌患者手术切除后预后显著优于男性肝癌患者，女性肝癌患者肿瘤较小，血管侵犯较少，肝内播散较少，但是雌激素仅对早期女性肝癌患者的生存有提高作用，而对晚期女性肝癌患者的作用不明显。尽管女性肝癌患者AFP升高的比例较高，但是女性肝癌患者AFP的水平并不能反映患者的预后。血管侵犯和GGT水平是女性患者术后早期复发的危险因素，而AFP和GGT水平是女性肝癌患者晚期复发的危险因素。这些创新性的研究结果对于提高女性肝癌患者的预后及判断其术后复发转移的风险具有重要的临床价值。

       Clinical characteristics, outcome, and risk factors for early and late intrahepatic recurrence of female patients after curative resection of hepatocellular carcinoma

Tao Li, MD DOI: http://dx.doi.org/10.1016/j.surg.2014.04.008

Background

       There have been progressive increases in both the incidence and death rates of female patients with hepatocellular carcinoma (HCC). Our objective was to investigate the clinicopathologic characteristics and prognostic factors influencing the recurrence and survival of female patients with HCC.

Methods

       We performed a retrospective analysis of 459 consecutive female and 2,936 male patients with HCC who underwent curative resection. Multivariate competing risks analyses with Bonferroni correction were used to evaluate independent prognostic factors.

Results

       Female patients had a better overall survival rate (P = .001) than male patients, but a survival benefit was only observed in female patients with tumor-node-metastasis stage I diseases compared with male patients of the same stage (P = .023). Female patients less often had multiple tumors, vascular invasion, and larger tumors. Although female patients had a greater prevalence of increased serum alpha-fetoprotein (AFP), AFP and tumor number had prognostic significance only for male but not for female patients. The incidence of recurrence in female patients was not different than male patients (P = .130). Vascular invasion and serum γ-glutamyl transpeptidase level were independent risk factors for early recurrence of female patients, whereas AFP and γ-glutamyl transpeptidase level were independent risk factors for late recurrence. After curative treatment for recurrence, female patients still had a better overall survival than male patients (P = .025).

Conclusion

       Female patients had a less invasive tumor phenotype and different prognostic factors from male patients. AFP had no prognostic value in female patients. Estrogen may have a protective effect against early- but not late-stage HCC. Female patients have a better outcome after curative resection of recurrent HCC.