原发性肝癌骨转移患者预后相关影响因素分析

Analysis of prognosis of primary hepatic carcinoma patients with bone metastasis

目的分析原发性肝癌(primary hepatic carcinoma,PHC)骨转移患者预后相关影响因素。方法回顾性分析福建省立医院收治的112例PHC骨转移患者行外照射治疗的临床效果,对PHC骨转移的疼痛进行分级,分别记录1、2、3年生存率,及放疗后疼痛改善情况,对性别、骨转移病灶、肝内病灶、骨转移时AFP水平、r-GT水平、骨转移是否伴有骨旁软组织或其他脏器转移,以及肝内灶是否手术治疗和肝内灶控制情况等影响PHC骨转移患者远期生存率的相关因素进行分析。运用Kaplan-Meier法进行生存分析,单因素分析采用Logrank法,多因素分析采用Cox回归模型。结果 112例PHC骨转移部位多见于腰椎(25.89%)、骶髂骨(19.64%)和胸肋骨(17.86%);肝癌确诊后3年生存率为15.18%,骨转移确诊后3年生存率为9.82%;肝内病灶数量、骨转移诊断时r-GT水平、骨转移是否伴其他脏器(组织)转移、肝内灶是否行手术治疗以及肝内病灶控制情况均为影响PHC骨转移患者3年生存率的独立危险因素(P<0.05),其余因素与生存率无明显相关。结论外照射治疗可明显改善PHC骨转移患者疼痛症状,但远期生存率较低,肝内病灶数量、骨转移诊断时r-GT水平、骨转移是否伴其他脏器(组织)转移、肝内灶是否行手术治疗,以及肝内病灶控制情况均为影响患者远期生存率独立危险因素。

Objective To analyze factors that affect prognosis of patients of primary liver cancer （primary hepatic carcinoma PHC ） with bone metastasis. Methods A retrospective analysis was made of the clinical effect of external irradiation among 112 cases of PHC with bone metastasis treated at Fujian Provincial Hospital. The pain caused by PHC with bone metastasis was graded. The 1, 2, and 3-year survival rate and the intensity of pain after radiation therapy were recorded. Such related factors as the gender of pa- tients, liver lesions, bone metastasis, AFP levels, r-GT levels and control of lesions in the liver were analyzed using Kaplan-Meier method. The Logrank method was used for univariate analysis while the Cox regression model was used for multivariate analysis. Results Among the112 cases of PHC, 25.89% of the cases of bone metastasis were detected in lumbar, 19.64% in the sacro-iliac joint and 17.86% in the chest and ribs. The 3-year survival rate after the diagnosis of liver cancer was 15.18% , and thatof bone me- tastasis was 9.82%. The number of lesions, levels of bone metastasis in the liver, transfer of bone metastasis to other organs （tissues） were risk factors （ P 〈 0.05） that had some effect on the 3-year survival rate of patients of PHC with bone metastasis. The remaining factors were not significantly correlated with the survival rate. Conclusions The external radiation therapy can significantly alleviate the pain of patients of PHC with bone metastasis, but lower long-term survival rates, number of lesions in the liver, r-GT levels , bone metastases with other organs （ tissues）, foci in the liver and control of liver lesions affect the long-term survival rate of patients.