原发性肝癌自发破裂出血患者近期及远期预后因素分析

Analysis of short- and long-term prognostic factors for patients with spontaneous rupture and bleeding of primary liver cancer

目的探讨原发性肝癌(肝癌)自发破裂出血患者近期及远期预后的影响因素。方法回顾性分析2005年1月至2012年12月在南方医科大学附属江门医院及广东医学院附属南山医院接受治疗的167例肝癌自发破裂出血患者临床资料。所有患者均签署知情同意书,符合医学伦理学规定。其中男140例,女27例,平均年龄(58±7)岁。肝功能Child-Pugh分级A级78例,B级44例,C级45例。肿瘤TNM分期Ⅱ期31例,Ⅲ期54例,ⅣA期73例,ⅣB期9例。分析患者30 d生存率及远期生存率。生存率影响因素分析采用Cox比例回归风险模型。结果患者30 d生存率为71.3%,1、3、5年累积生存率分别为40.1%、16.5%、5.4%。多因素Cox回归分析显示肝功能ChildPugh分级C级、失血性休克、肿瘤数量≥2个、肿瘤TNM分期Ⅲ期和保守治疗为患者30 d生存率的独立危险因素(HR=9.503,2.919,4.760,0.283,32.004;P<0.05)。肝硬化、肝功能Child-Pugh分级C级、TB≥34μmol/L、肿瘤数量≥2个、肿瘤TNM分期Ⅲ期和保守治疗为患者远期生存率的独立危险因素(HR=9.167,5.950,1.037,2.821,0.680,8.147;P<0.05)。结论肝功能Child-Pugh分级C级、失血性休克、肿瘤数量≥2个、肿瘤TNM分期Ⅲ期和保守治疗为肝癌自发破裂出血患者近期预后的独立危险因素。而肝硬化、肝功能Child-Pugh分级C级、TB≥34μmol/L、失血性休克、肿瘤数量≥2个、肿瘤TNM分期Ⅲ期和保守治疗为其远期预后的独立危险因素。

Objective To investigate the short- and long-term prognostic factors for patients with spontaneous rupture and bleeding of primary liver cancer (liver cancer). Methods Clinical data of 167 patients with spontaneous rupture and bleeding of liver cancer admitted to Jiangmen Hospital, Southern Medical University and Nanshan Hospital, Guangdong Medical College between January 2005 and December 2012 were retrospectively analyzed. There were 140 males and 27 females with the average age of (58±7) years. The informed consents of all patients were obtained and the local ethical committee approval was received. Seventy-eight cases were diagnosed with Child-Pugh classiifcation A, 44 with Child-Pugh classiifcation B and 45 with Child-Pugh classiifcation C. According to the tumor, node, metastasis (TNM) stage, 31 cases were in stageⅡ, 54 in stageⅢ, 73 in stageⅣA and 9 in stageⅣB. The 30-d and long-term survival rates were analyzed. The inlfuencing factors of survival rates were analyzed by Cox's proportional hazard regression model. Results The 30-d survival rate was 71.3%, and the 1-, 3-, 5-year accumulative survival rate was 40.1%, 16.5%, 5.4% respectively. Multiviariate Cox's regression analysis revealed that Child-Pugh classiifcation C, hypovolemic shock, number of tumors≥2, TNM stage Ⅲ and conservative therapy were the independent risk factors for 30-d survival rate (HR=9.503, 2.919, 4.760, 0.283, 32.004; P<0.05). Liver cirrhosis, Child-Pugh classification C, total bilirubin (TB)≥34 μmol/L, number of tumors≥2, TNM stageⅢand conservative therapy were the independent risk factors for long-term survival rate (HR=9.167, 5.950, 1.037, 2.821, 0.680, 8.147; P<0.05). Conclusions For patients with spontaneous rupture and bleeding of liver cancer, Child-Pugh classiifcation C, hypovolemic shock, number of tumors≥2, TNM stageⅢand conservative therapy are the independent risk factors for short-term pronosis, whereas liver cirrhosis, Child-Pugh classiifcation C, TB≥34μmol/L, number of tumors≥2, TNM stageⅢand conservative therapy are the independent risk factors for long-term pronosis.