乙、丙型肝炎病毒感染与原发性肝癌预后相关性研究

Analysis of relationship between hepatitis B or C virus infection and hepatocellular carcinoma prognosis

目的 探讨乙、丙型肝炎病毒感染与原发性肝癌预后相关的新因素.方法 回顾性分析已确诊的130例原发性肝癌病例,应用Cox回归模型针对有意义的因素及既往曾报道的与原发性肝癌预后有关的可能因素进行多因素分析,筛选出有独立显著意义的预后因素.结果 HBV DNA、HCV RNA水平、病毒感染持续时间与中位生存期呈直线负相关,与肿瘤复发或转移率成直线正相关；不同治疗模式的预后差异有统计学意义（P＜0.05）；乙、丙型肝炎病毒载量、病毒感染持续时间、治疗模式、治疗前血清甲胎蛋白（AFP）水平、child-Pugh分级以及是否存在肝外远处转移、门脉癌栓对原发性肝癌患者预后影响显著（P＜0.05）；与HBV相关原发性肝癌患者相比,HCV相关原发性肝癌患者中位生存期较长,1～3年内的累积生存率较高,具有较好的预后,差异均有统计学意义（P＜0.05）.结论 HBV DNA、HCV RNA水平、病毒感染持续时间是与原发性肝癌预后相关的新因素.

Objective To investigate the relationship between hepatitis B or C virus infection and hepatocellular carcinoma prognosis. Methods A follow-up retrospective analysis of 130 patients who hadbeen diagnosed as primary hepatoeareinoma （PHC） in our hospital was performed. The possible factors and the factors that had been reported previously meaningful to PHC were analyzed with Cox regression （ multivariate analysis）. Independent significant prognostic factors were to be screened out. Results HBV DNA, HCV RNA level, and duration of viral infection were negatively correlated with the median survival, respectively. However, they had a positive linear correlation with rate of tumor recurrence or metastasis, respectively. There was a significant difference in prognosis a- mong different treatment modalities （ P 〈 0.05 ） ; The viral load of hepatitis B and C, virus infection duration, treatment modalities, pretreatment serum AFP level, bilirubin levels and the presence of ascites, extrahepatic metastasis and portal vein thrombosis had significant impact on the prognosis of patients with PHC （ P 〈 0. 05 ）. Compared with HBV-related PHC patients, HCV-related PHC patients had the longer median survival period, the cumulative survival rate at 3 years was higher, and the prognosis was better, with a statistically significant difference （ P 〈 0. 05）. Conclusions HBV DNA, HCV RNA level and duration of viral infection were the new factors that were associated with hepatocellular Carcinoma prognosis.