影响乙型肝炎病毒相关原发性肝癌患者生存因素分析

Risk factors influencing survival of patients with hepatitis B virus-related primary liver cancer

目的分析乙型肝炎病毒相关原发性肝癌(HBV-PLC)患者生存期及其影响因素。方法收集2011年11月至2014年6月我院119例HBV-PLC患者临床资料,应用Kaplan-Meier检验及Cox回归模型,分析影响HBV-PLC患者生存期的因素。结果在119例HBV-PLC患者中,终末期肝癌比例较高,BCLC D期患者41例(34.5%),Child-Pugh C级79例(66.4%),伴有基础疾病78例(65.5%),肿瘤肝内或肝外转移90例(75.6%),患者中位生存期为287(172,560)d;在HBV-PLC确诊前未抗病毒治疗、抗病毒治疗持续时间<1年、1~3年和>3年患者的中位生存期分别为232(114,390)d、357(179,879)d、530(206,-)d和795(384,912)d(P<0.01);Cox回归分析提示,民族、Child-Pugh分级、肿瘤转移、年龄、抗病毒治疗、血清HBV DNA水平和肿瘤治疗方式是预测患者生存期的重要因素,相对危险度分别为3.18、1.60、4.86、1.82、1.30、5.88和1.13(P<0.05或P<0.01)。结论影响HBV-PLC患者生存期的因素很多,早期监测、早期干预、规范抗肿瘤治疗将有助于延长HBV-PLC患者的生存期。

Objective To clarify the prognostic factors that influence the overall survival （OS）in patients with hepatitis B virus-related primary liver carcer （HBV-PLC）. Methods The clinical data of 119 patients with HBV-PLC from November 2011 to June 2014 in our hospital were retrospectively reviewed,and OS was analyzed by using Kaplan-Meier method,I^g-rank test and Cox proportional hazard model. Results There were 41 cases （34.5%） with terminal stage of tumor [Barcelona Clinic Liver Cancer （BCLC）stage D ],79 （66.4%） with Child- Pugh class C,78（65.5%） with pre-existing diseases,and 90（75.6%） with tumor metastasis among the 119 patients with HBV-PLC;The median overall survival in this series was 287 （172,560） days,and the median overall Survivals of patients with non-antiviral therapy,with antiviral therapy for less than one year,with antiviral therapy for one to three years,and with antiviral therapy for more than 3 years were 232 （114,390） days,357（179,879） days, 530 （206-）days, and 795 （384,912） days （P〈0.01 ） ; The Cox proportional-hazards model demonstrated that nationality [relative risk（RR）=3.18,95% CI,1.71-5.91,P=0.000],Child-Pugh elass（RR=1.60,95%CI,1.180--2.16, P=0.002）,tumor metastasis （RR=4.86,95%CI,2.72--8.68,P=0.000）,age （RR=1.82,95%CI, 1.13 ~2.95,P=0.014）, antiviral therapy prior to diagnosis of HBV-PLC （RR=l.30,95%CI,1.00--1.69,P=0.048）,serum HBV DNA level （RR=5.88,95%CI,3.22~10.71,P=0.000）and the way targeting tumor therapy （RR=1.13,95%CI,1.01--1.26,P= 0.025） were significant predictor of overall survival. Conclusion Many factors might influence the overall survival of patients with HBV-PLC,and the rigorous screening and surveillance in the HBV-infected populations, and effective antiviral therapy for HBV infection are important for prolonging the life of patients with PLC.