原发性肝癌患者临床诊疗现状分析及多学科协作诊疗的初步探讨

A retrospective analysis of clinical diagnosis and multi-disciplinary team treatment in patients with primary liver cancer

目的：了解原发性肝癌（PLC）住院患者的临床基本特征及诊疗现况，探讨多学科协作诊疗模式（MDT）在原发性肝癌治疗中的应用价值。方法2010年1月1日～2013年12月31日期间在南方医院诊疗的PLC患者5390例，对患者的性别、年龄、病因、HBeAg定性、HBV DNA定量、AFP定量、Child-Pugh分级、BCLC分期、治疗方式等临床资料进行回顾性分析。结果本组PLC患者以男性为主（87.4%），中位年龄为53岁，HBV感染率为84.15%， AFP阳性（≥20μg/L）率为65.63%；HBeAg阳性患者AFP阳性率为76.95%（671/872），高于HBeAg阴性患者的54.11%（685/1266）或HBV DNA阳性（≥1.0×103 IU/ml）患者的70.73（1022/1445，P〈0.01）；患者年龄越小、肝功能越差、BCLC分期越晚，AFP阳性率越高（P〈0.01）；PLC病理学分型以肝细胞癌（HCC）为主（84.7%）；BCLC分期以 C期（41.0%）和B期（31.0%）为主；仅10%PLC患者经过综合治疗；在1051例PLC患者中，初治即接受MDT诊疗的56例（5.3%），而28例（2.7%）非初治患者接受了MDT诊疗；在常规治疗情况下，单次平均住院费用为28234元，而MDT治疗的平均住院费用为26307元，费用减少了6.83%。结论 PLC患者多并有慢性HBV感染，且发病住院时多为中晚期，MDT诊疗模式可以减少住院费用。

Objective To investigate the clinical features of patients with primary liver cancer （PLC）,and the current states of clinical diagnosis and multi-disciplinary team（MDT） management in clinical practice. Meth-ods The clinical data of 5390 patients with PLC enrolled in our general hospital in south China from 1st Jan, 2010 to 30th Dec,2013 were retrieved,and we reviewed the patient＆#39;s gender,age,etiology,qualitative detection of serum HBeAg,HBV DNA and alpha fetoprotein （AFP） levels,Child-Pugh class,Barcelona clinic liver cancer （BCLC） stages and the strategy of treatment for them. Results The median age of 5390 patients was 53-year-old,while male persons accounted for 87.4% and the prevalence of hepatitis B virus （HBV） infection was 84.15%;serum AFP positive （≥20 μg/L） accounted for 65.63%,and in HBeAg positive patients was 76.95%（671/872）, much higher than that in HBeAg negative patients [54.11%（685/1266）,P〈0.01];serum HBV DNA positive （≥1.0 ×103IU/ml） was 70.73 %（1022/1445）;as for pathological classification,the hepatocellular carcinoma （HCC） ranked first （84.7%）;the patients with BCLC stage C was 41.0% and B 31.0%;only 10% of PLC patients re-ceived comprehensive treatment;There were 56（5.3%） out of 1051 patients at initial admission,and 28 （2.7%） at repeated admission receiving MDT therapy;the hospitalization fee for conventional management was 28 thousand RMB,which was reduced by 6.83% to 26 thousand for MDT treatment. Conclusion The patients with PLC are often with underlying chronic HBV infection and are likely to be in advanced stage when hospitalized. The MDT should be recommended for their diagnosis and treatment.