中晚期原发性肝癌的预后因子分析

A Study on the Prognosis Factors for 308 Patients of Late and Middle Stages of Primary Liver Cancer

目的：评价影响中晚期肝癌疗效的预后相关因子。方法：本研究中我们通过回顾性调查广东省中医院肿瘤内科近6年收治的肝癌病人，从中筛选出已死亡的病例共308例，选定23个可能与远期疗效相关的预后因子，用COX回归模型分析影响远期疗效的因素。并通过PI公式计算每个病人的PI值，比较PI值大小对病人生存率的影响。结果：单因素COX回归模型分析显示肝硬化病史、中医辨证分型、临床分期、介入栓塞等16个因子对肝癌的预后有显著性意义（P〈0．01）。多因素COX模型分析显示临床分期、肿瘤大小、中医分型、有无栓塞、中医药治疗等11个因子是影响肝癌预后的重要因素，有显著性的统计学差异（P〈0．01）。预后指数分析发现，病人的累积生存率随着PI值的增大而下降。结论：①中医药治疗、中药剂数、栓塞治疗、有无包膜和介入次数为对中晚期PLC有保护作用的预后因子；②能缩短中晚期PLC的累计生存率的危险因子有中医分型、Chi1d-pugh分级、临床分期、肿瘤大小、病灶数目、门静脉癌栓；③预后指数（PI）能有效地预测病人的预后，PI越减小，预后越好，PI越增大，预后越差。

Objective To analyse the prognosis factors for the therapeutic Medium-stage or late-stage PLC. Methods 308 dead cases of medium or late effects of. stage of PLC treated in the last six years by Tumour Department of Guangdong provincial Hospital of Traditional Chinese Medicine were retrospectivly studied. 23 prognosis factors were selected, and were analysed by the cox regression method. Then dangerous factors and protective factors were screened out, which may offer referece for clinical treatment of PLC in the future. Results By the single factor cox regression method, 16 factors such as T.C.M syndrome differentiation of tumor, hepatocirrhosis, intervenes embolism and etc show a important significance on the prognosis of PLC （P〈0.01）. And by the multiple factor cox regression method, 11 factors such as T.C.M syndrome differentiation of tumor, clinical staging, tumor size, treatment of T.C.M and etc also show a important significance on the prognosis of PLC （P〈0.01）.The analysis of RI（Prognosis Index） shows that the cumulative survival rate of PLC descents will come with the increasing of PI. Conclusion ①Application of Chinese medicine, intervenes embolism , presence of tumor envelope and the frequency of interventional therapy is implied to be a protective factors to metaphase and late PLC.②Dangerous factors composed of T.C.M syndrome differentiation of tumor, Child＇s grade of liver function, clinical staging, tumor size, number of lesions, existence of cancerous emboli of PV and etc can shorten the cumulative survival rate.③PI can effectively predict the survival time of a given group of patients with PLC which means that the decreasing of PI will lead to a better prognosis and on the contrary a worse prognosis will come with the increasing of PI.