140例BCLC分期C期原发性肝癌患者的临床特征及预后影响因素分析

Clinical features of patients with Barcelona Clinic Liver Cancer stage C primary liver cancer and related prognostic factors: An analysis of 140 cases

目的探讨晚期原发性肝癌(BCLC分期C期)患者临床特征及预后影响因素。方法回顾性分析2008年10月-2015年12月首都医科大学附属北京地坛医院收治的140例BCLC分期C期原发性肝癌患者的临床资料。采用Kaplan-Meier法进行生存分析,log-rank进行单因素分析。将预后影响因素按LR法(基于最大似然估计向前逐步回归)进行多因素Cox回归分析。结果140例患者中以男性为主,男女比例为6∶1,腹痛或肝区痛、乏力及腹胀是肝癌最常见的3个首发症状。中位生存期为6个月,中位随访时间10(1~80)个月。纳入患者1年生存率为22.14%。单因素分析结果显示性别、Child-Pugh分级、门静脉癌栓情况、肿瘤个数、肿瘤形态、肿瘤直径、AST/ALT、是否接受TACE与预后有关(χ~2值分别为6.215、19.609、8.849、11.122、11.571、7.438、30.511、10.690,P值均<0.05);多因素分析结果显示,Child-Pugh分级[比值比(OR)=1.524,95%可信区间(95%CI):1.011~2.297,P=0.044]、肿瘤直径(OR=1.803,95%CI:1.097~2.964,P=0.020)、AST/ALT(OR=1.769,95%CI:1.301~2.406,P<0.001)是影响晚期原发性肝癌预后的独立危险因素,而行TACE(OR=0.598,95%CI:0.363~0.985,P=0.043)为保护因素。结论晚期原发性肝癌预后差,中位生存期短,建议尽可能根据患者预后不良因素进行更准确的生存获益分析,指导临床采取适宜的治疗模式,而AST/ALT升高者应当引起关注。

Objective To investigate the clinical features of patients with Barcelona Clinic Liver Cancer（ BCLC） stage C primary liver cancer（ PLC） and related prognostic factors. Methods A retrospective analysis was performed for the clinical data of 140 patients with BCLC stage C PLC who were admitted to Beijing Ditan Hospital,Capital Medical University,from October 2008 to December 2015. The Kaplan-Meier method was used for survival analysis,and the log-rank test was used for univariate analysis. The multivariate Cox proportional hazards model was used to analyze prognostic factors according to forward stepwise regression based on maximum likelihood estimation. Results Most of the 140 patients were male,and the male/female ratio was 6∶ 1. The three most common initial symptoms of PLC were abdominal pain or liver area pain,weakness,and abdominal distension. The median survival time was 6 months,and the median follow-up time was 10 months（ 1-80 months）. The 1-year survival rate of these patients was 22. 14%. The univariate analysis showed that Child-Pugh class,the type of portal vein tumor thrombus,tumor number,tumor morphology,tumor diameter,aspartate aminotransferase/alanine aminotransferase（ AST/ALT） ratio,and use or non-use of transcatheter arterial chemoembolization（ TACE） were associated with prognosis（ χ-2= 6. 215,19. 609,8. 849,11. 122,11. 571,7. 438,30. 511,and 10. 690,all P〈0. 05）. The multivariate analysis showed that Child-Pugh class（ odds ratio [OR]= 1. 524,95% confidence interval [CI]： 1. 011-2. 297,P = 0. 044）,tumor diameter（ OR = 1. 803,95%CI： 1. 097-2. 964,P = 0. 020）,and AST/ALT ratio（ OR = 1. 769,95% CI： 1. 301-2. 406,P〈0. 001） were independent risk factors for the prognosis of advanced PLC,while the use of TACE was a protective factor（ OR = 0. 598,95% CI： 0. 363-0. 985,P = 0. 043）.Conclusion Advanced PLC has poor prognosis and short median survival time. A more accurate survival benefit analysis should be performed based on adverse prognostic factors to guide the selection of therapeutic paradigms in clinical practice. Increased AST/ALT ratio should also be taken seriously.