原发性肝癌骨转移的临床病理特征及预后因素分析

Clinicopathological features and survival of bone metastasis from primary hepatic carcinoma

目的 探讨原发性肝癌骨转移患者的临床病理特征和预后因素.方法 回顾分析天津医科大学肿瘤医院2005年1月至2014年6月间收治的80例原发性肝癌骨转移患者的临床资料,描述原发灶和骨转移灶的临床病理特征,并分析相关预后因素.生存分析采用Kaplan-Meier法,单因素分析采用Log-rank法,多因素分析采用Cox回归模型.结果 患者中位生存期4.7（95％ CI3.4～6.0）个月,6、12、24个月生存率分别为42.5％、17.5％、2.5％.单因素分析显示,Child-Pugh分级（P＜0.01）、ECOG评分（P=0.014）、胆碱酯酶（P=0.002）、总胆红素（P=0.006）、腹水（P =0.003）、TACE治疗（P＜0.01）是影响预后的相关因素.多因素分析显示,Child-Pugh分级（P＜0.01）、TACE治疗（P＜0.01）是独立预后因素.结论 肝癌合并骨转移预后差,积极局部TACE联合药物保肝治疗可改善患者预后.

Objective To explore clinicopathological features and prognostic factors of bone metastasis from primary hepatic carcinoma （PHC）.Methods Eighty patients were enrolled with bone metastasis from PHC in Tianjin Medical University Cancer Institute and Hospital from January 2005 to June 2014 respectively.The clinicopathological features and prognostic factors of primary tumor were collected and bone metastases.Kaplan-Meier method was adopted for survival analysis.Log-rank method and Cox regression were used for univariate and multivariate analysis.Results The median survival was 4.7 （95% CI range from 3.4 to 6.0） months.The 6-,12-,and 24-month survival was 42.5%,17.5%,2.5%,respectively.Univariate analysis indicated that Child-Pugh grading （P 〈0.01）,ECOG score （P =0.014）,serum cholinesterase（P =0.002）,total bilirubin （P =0.006）,ascites （P =0.003）,TACE （P 〈 0.01） were significant prognostic factors of survival.Multivariate analysis revealed that Child-Pugh classification （P 〈 0.01）,TACE （P 〈 0.01） were independent prognostic factors of survival.Conclusion Bone metastasis from PHC patients had poor survival.Patients can benefit from TACE and liver protecting treatment.