回顾性总结56例肝细胞癌合并肝外原发恶性肿瘤

Primary hepatocellular carcinoma associated with extra-hepatic malignancies: retrospective analysis of 56 cases

目的分析肝细胞癌合并肝外原发恶性肿瘤患者的临床特征。方法回顾性分析56例原发性肝细胞癌合并肝外原发恶性肿瘤患者临床特征,包括肝外原发恶性肿瘤分布部位、治疗方式、与肝细胞癌发生的时间关系;对肝细胞癌患者确诊时的临床特征进行描述,对影响多原发恶性肿瘤患者总生存期及肝细胞癌患者特异生存期的临床特征进行单因素、多因素分析。结果肝外原发恶性肿瘤多发部位依次为胃、结肠直肠、鼻咽部和肺部;24例为同时诊断恶性肿瘤,32例为先后诊断恶性肿瘤;67.9%患者会在出现第1个原发肿瘤后3年内再发生第2个原发肿瘤。同时癌与异时癌比较,两组在年龄、性别、肝炎、血清甲胎蛋白、肝功能Child-Pugh分级、巴塞罗那分期、肝细胞癌治疗方式、肝外原发肿瘤治疗方式、肝硬化、肿瘤数目、肿瘤最大直径、门静脉侵犯、肿瘤家族史、吸烟史等各组间差异均无统计学差异(P>0.05)。多因素分析显示,肝外原发肿瘤治疗方式及同时癌、异时癌分组会影响多原发恶性肿瘤患者的总生存期。生存分析显示:肝外原发恶性肿瘤获得根治性治疗以及异时癌组患者可获得较好的总生存期;肝细胞癌治疗方式、肝功能Child-Pugh分级是影响肝细胞癌特异生存期的临床因素;患者接受根治性手术切除、肝功能Child-Pugh A级患者可获得较长的肝细胞癌特异生存期。结论肿瘤患者治疗后应进行定期复查,特别是最初3年对胃、结肠直肠、鼻咽部和肺部等高发部位的筛查;对肝内、肝外肿瘤积极治疗可以获得较好的生存期。

Objective To analyze the clinical features of primary hepatocellular carcinoma（HCC）complicated by multiple extra- hepatic malignancies. Methods A total of 56 HCC patients accompanied by multiple extra- hepatic malignancies（multiple primary malignancies, MPM） were enrolled in this study. The clinical data, including the clinical manifestations, the locations of extra- hepatic malignancies, the therapeutic methods, and the time- relationship of the occurrence of HCC with the occurrence of extra- hepatic malignancies, were retrospectively analyzed. The clinical features when HCC was confirmed were described.The clinical factors which might affect on the overall survival time of MPM patients as well as on the specific survival time of HCC patients were statistically analyzed by using univariate analysis and Cox modeling methods. Results The common locations of extra- hepatic malignancies were, in a descending order,stomach, colorectum, nasopharynx and lung. Of the 56 patients, coinstantaneous tumors was seen in 24（coinstantaneous group） and non- coinstantaneous tumors in 36（non- coinstantaneous group）. In 67.9% of patients, the second cancer appeared within three years after the initial cancer was diagnosed. No statistically significant differences（P 0.05） existed between the two groups in the following indexes： age, gender,presence of hepatitis, AFP, Child- Pugh grading, BCLC stage, therapeutic methods HCC and extra- hepatic malignancies, presence of cirrhosis, number of tumor, the largest diameter of tumor, portal vein invasion,family history of cancer, smoking history, etc. Cox modeling analysis indicated that therapeutic methods for extra- hepatic malignancies and the classifications for coinstantaneous and non- coinstantaneous tumors could affect the total survival time of MPM patients. Survival analysis showed that radical therapy for extra- hepatic malignancies and patients in non- coinstantaneous group had a better total survival time. The therapeutic methods and Child- Pugh grading were the clinical factors that affected the specific survival time of HCC patients. Patients who had received radical surgery and had Child- Pugh grading A could get longer HCC specific survival time. Conclusion Regular check- up should be conducted for patients with malignancies after treatment, especially during the first 3 years cancer screening for the malignancies of stomach,colorectum, nasopharynx and lung is obligatory. Active treatment for both HCC and extra- hepatic malignancies can definitely extend the survival time.