中、晚期原发性肝癌患者的生存因素分析

Prognostic factors of patients with advanced primary hepatic cancer

目的探讨影响中、晚期原发性肝癌患者生存的因素。方法回顾性分析173例住院患者资料,将Child-Turcotte-Pugh(CTP)分级作为分层因素,从性别、年龄、终末期肝病模型(MELD)评分、肿瘤淋巴结转移(TNM)分期、临床生化指标、病因等方面研究影响患者生存的因素。采用Cox比例风险模型进行生存多因素分析。结果年龄和TNM分期是影响CTP A级患者生存的独立危险因素,抗病毒治疗是患者生存的保护性因素;血清总胆红素、直接胆红素、前白蛋白和MELD评分是影响CTP B、C级患者生存的独立危险因素,介入治疗和抗病毒治疗是降低患者死亡风险的保护性因素。结论中、晚期原发性肝癌患者应重视抗病毒治疗;CTP A级的中、青年患者应积极地抗癌治疗;CTP B、C级患者尤应注重保护肝功能。

Objective To investigate the prognostic factors of patients with advanced primary hepatic cancer（PHC）.Methods A total of 173 patients with advanced PHC had been enrolled into the study from January 2005 to March 2009.All patients were followed up at least 1 year. Child-Turcotte-Pugh（CTP）class was considered as a stratification factor.Factors,such as age, gender,model for end-stage liver disease（MELD）score,clinic biochemistry indexes,the tumor lymph node metastasis（TNM）staging system and cause of PHC,were conducted by univariate and multivariable analysis to determine the independent prognostic predictors.Results By multivariable analysis,age and TNM staging system were associated with higher mortality in patients with CTP class A;serum total bilirubin,serum direct bilirubin,serum prealbumin,MELD score and intervention therapy were significant predictors of mortality throughout follow-up in patients with CTP class B and C.The antiviral therapy was the only significant favorable prognostic factor for patents.Conclusion Patients with advanced PHC should pay more attention to antiviral therapy.The younger PHC patients with CTP class A should take actions in anticancer therapy and patients with CTP class B and C should put emphasis on protection of their liver functions.