肝细胞癌的肝病背景及其对预后的影响

MULTTVARIATE ANALYSIS OF PROGNOSIS IN VIRAL HEPAimS-OR CIRRHOSIS-ASSOCIATED HEPATOCELLULAR CARCINOMA:AN ANALYSIS OF 328 CASES

目的:探讨肝细胞癌(HCC)的肝病背景及其对预后的影响。方法:采用酶联免疫法测定328例HCC患者血清中各种肝炎病毒感染标志,并对预后进行多因素分析。结果:HBV、HCV和HEV的感染率分别为98.2％、10.4％和13.9％。286例合并肝硬变,占87.2％。HBV合并HCV感染和无合并HCV感染时的1、2、3年生存率分别是46.3％、32.7％、25.9％和64.1％、59.3％、48.2％(P=0.0263)。多因素分析显示HBV与HCV的双重感染和肝硬变为对预后有显著影响的因素。结论:绝大部分的肝细胞癌在临床上显示出明显的肝病背景表现。HBV是我国肝癌发生的主要原因,HCV可能在肝癌发生中起部分作用,鉴于HEV有较高的发生率,其在肝癌病因中的作用值得注意。HBV与HCV的双重感染和伴发肝硬变对肝癌术后的预后有不良影响。

To explore the influences of underlying hepatotropic virus infections or cirrhosis on postoperative prognosis of hepatocellular carcinoma ,we analyze 328 patients by COX regression method.The infection rates of HBV,HCV and HEV in this series of patients with HCC were 98.2% , 10.4% and 13.9% , respectively.We also found 87.7% (286/328) of patents had cirrhosis to a certain degree.The l-x2-,and 3-year survival rates in patients with HBV and HCV coinfection were lower than in those with HBV infection alone (46.3% ,32.7% and 25.7% vs.64.1 % ,59.3% and 48.2% ,P = 0.02).Multivariate analysis showed that HBV/HCV superinfection and cirrhosis but serum ALT, GGT and ratio of albumin and glubulin.had prognostic value.We conclude that hepatotropic virus infection and cirrhosis are closely related to the development of HCC.Among others, HBV infection is the most dangerous factor.HCV infection play a part in some (10%) cases.As to its relatively high prevalence in our series of HCC patients, HEV infection should be further investigated.