HBV相关性肝癌患者合并不同程度肝硬化对预后的影响

The influence of different degrees of cirrhosis on the prognosis of patients with hepatitis B virus-associated hepatocellular carcinoma

目的研究乙肝相关性肝癌合并不同程度肝硬化对预后的影响。方法纳入2016年1月至2020年10月收治的108例乙肝相关性肝癌患者作为研究对象,随访记录患者的生存率,比较不同肝硬化程度患者临床病理特征指标水平,分析肝硬化程度与预后的关系。结果108例患者随访2~56个月,死亡26例,生存率75.93%。不同程度肝硬化患者预后差异有统计学意义(P<0.05)。不同肝硬化程度患者肿瘤分化程度、血管侵犯及肿瘤分期水平比较,差异均有统计学意义(P<0.05)。Cox多因素风险回归模型分析显示,分化情况(95%CI=1.859~4.887,HR=3.014,P<0.001)、血管侵犯(95%CI=1.075~7.403,HR=2.821,P=0.035)、肿瘤分期(95%CI=1.602~3.867,HR=2.489,P<0.001)、治疗方案(95%CI=1.462~2.971,HR=2.084,P<0.001)及肝硬化程度(95%CI=1.118~1.580,HR=1.329,P=0.001)是乙肝相关性肝癌预后的独立影响因素(P<0.05)。根据Cox分析结果建立预测模型:Y2=1.103X1+1.037X2+0.912X3+0.734X4+0.284X5(X1=分化程度,X2=血管侵犯,X3=肿瘤分期,X4=治疗情况,X5=肝硬化程度)。该模型判断预后的AUC为0.840(SE=0.042,95%CI=0.758~0.922,P<0.001)。结论乙肝相关性肝癌患者合并肝硬化程度与预后密切相关,基于肝硬化程度建立的预测模型对判断预后具有较高准确性。

Objective To investigate the influence of different degrees of cirrhosis on the prognosis of the patients with hepatitis B virus-associated hepatocellular carcinoma(HBV-HCC).Methods One hundred and eight patients with HBV-HCC from January 2016 to October 2020 were enrolled as the research subjects.The survival rate was calculated.The levels of clinicopathological characteristics of patients with different degrees of cirrhosis were compared.The relationship between the degree of cirrhosis and prognosis was analyzed.Results During 2-to 56-month follow-up,26 of the 108 patients died.The survival rate was 75.93%.The prognosis of patients with different degrees of liver cirrhosis was significantly different(P<0.05).There were significant differences in tumor differentiation,vascular invasion and tumor staging among patients with different degrees of cirrhosis(P<0.05).The Cox multivariate regression model showed that the differentiation degree[95%confidence interval(CI)=1.859~4.887,hazard ratio(HR)=3.014,P<0.001],vascular invasion(95%CI=1.075~7.403,HR=2.821,P=0.035),tumor stage(95%CI=1.602~3.867,HR=2.489,P<0.001),treatment plan(95%CI=1.462~2.971,HR=2.084,P<0.001)and the degree of cirrhosis(95%CI=1.118~1.580,HR=1.329,P=0.001)were independent factors for the prognosis of HBV-HCC.According to Cox analysis,the prediction model was as follows:Y2=1.103×X1+1.037×X2+0.912×X3+0.734×X4+0.284×X5(X1=degree of differentiation,X2=vascular invasion,X3=tumor stage,X4=treatment,X5=degree of cirrhosis).Area under the curve(AUC)of the model to predict the prognosis was 0.840(sensitivity=0.042,95%CI=0.758-0.922,P<0.001).Conclusion The degree of liver cirrhosis in patients with HBV-HCC is closely related to the prognosis,and the prediction model based on the degree of liver cirrhosis has a high accuracy in predicting the prognosis.