原发性肝癌患者的临床诊疗特点分析

Clinical analysis of hospitalized patients with primary liver cancer

目的了解南方某三甲医院原发性肝癌(PLC)住院患者的基本特征和治疗特点。方法回顾性分析某院2010年1月至2011年12月间2353例PLC住院患者的临床资料。结果患者平均年龄(52.48±11.65)岁,男性占88.7%,82.7%的患者伴乙型肝炎病毒(HBV)感染。89.1%(386/433)为肝细胞癌,6.0%(26/433)为胆管细胞癌,4.8%(21/433)为混合型。33.1%(778/2353)患者AFP<20μg/L。巴塞罗那分期(BCLC)0～A期患者占27.0%,主要进行外科手术治疗(45.0%),联合治疗占14.9%;B期患者占19.0%,主要进行肝动脉化疗栓塞术(TACE)(43.0%),10.5%患者行联合治疗;C期患者占42.0%,主要是对症支持治疗(43.9%)和TACE治疗(40.0%),7.7%患者为联合治疗;D期患者占12.0%,其中对症支持治疗79.9%、TACE治疗15.2%和联合治疗1.5%。结论 PLC人群以中年男性HBV感染者占绝大多数,且以中晚期患者为主。规范化治疗有待进一步提高,多学科协作治疗模式有待进一步发展。

Objective This investigation was to elaborate the characteristics and management set of patients with primary liver cancer （PLC）. Methods This retrospective analysis involved the clinical data of 2 353 patients with PLC hospitalized in a hospital of southern China from January 2010 to December 2011. Results The mean age of patients with PLC was （52.48±11.65）years. Eighty-eight percent of invested patients were male and eighty-two percent were hepatitis B virus （HBV） infection-related. Of 433 patients with available histological data, 386（89.1%） were hepatocellular carcinoma （HCC） and 26 （6.0%） were cholangiocarcinoma. AFP values 20 μg / L were recorded in 778 （33.1%） patients. According to Barcelona Clinic Liver Cancer （BCLC） staging system, A to D stage was respectively in 27.0%, 19.0%, 42.0% and 12.0% of all cases. Patients with A stage were mainly treated with surgical operation （45.0%） and 14.9% received combined therapy. Patients with B stage were treated with TACE （43.0%） and combined therapy （10.5%）. Patients with C stage were treated with conservative treatment （43.9%）, TACE （40.0%） and combined therapy （7.7%）. Patients with D stage were received the conservative treatment （79.9%）, TACE （15.2%） and combined therapy （1.5%）. Conclusion In this survey, hospitalized patients with PLC were mainly middle-aged male with HBV-associated HCC. More than one-third patients had normal AFP levels. The majority of cases of PLC were in middle to late BCLC stage when they firstly visit to their doctors. Standardized treatment remains to be further improved and multi-disciplinary team （MDT） remains to be developed.