伴营养不良风险的原发性肝癌患者临床特征及预后因素分析

Clinical characteristics and prognostic factors of patients with primary liver cancer with malnutrition risk

目的:分析营养不良与原发性肝癌(PLC)患者临床特征及预后的关系。方法:收集2016年1月至2018年1月在开滦总医院接受肝肿物切除术后进行肝动脉化疗栓塞术(TACE)联合经皮微波消融术(MWA)治疗的PLC患者临床资料。根据营养风险筛查2002评分(NRS2002),判断患者是否伴营养不良风险,将其分为观察组49例(总分≥3分)和对照组51例(总分<3分),并随访时间2年以上。对比两组患者肝功能、临床特征及术后2年生存率。用Kaplan-Meier曲线进行生存分析,采用Log-rank检验,Cox多因素回归分析伴营养不良风险及其他因素对PLC患者预后的影响。结果:观察组患者肿瘤>5 cm、BCLC分期均显著高于对照组(P<0.05);术后,观察组患者白蛋白(Alb)、胆碱酯酶(CHE)水平显著低于对照组(P<0.05);天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)及直接胆红素(DBil)水平显著高于对照组(P<0.05)。观察组患者术后2年生存率显著低于对照组[65.31%(32/49)vs 82.35%(42/51),χ;=4.439,P=0.035]。单因素显示肿瘤大小、BCLC分期、伴营养不良风险、年龄、术后靶向药或联合PD-1是影响患者预后的因素;多因素分析显示,BCLC分期、伴营养不良风险是影响PLC患者预后的独立危险因素(P<0.05);术后靶向药或联合PD-1是影响预后的保护因素(HR=0.823,95%CI=0.753~0.894)。结论:伴营养不良风险是影响PLC患者预后的独立危险因素,伴营养不良风险的PLC患者在TACE联合MWA术后有更严重的肝损害及更快的肿瘤进展,预后更差。

Objective:To analyze the relationship between malnutrition and clinical characteristics and prognosis of patients with primary liver cancer(PLC).Methods:The clinical data of PLC patients who underwent transcatheter arterial chemoembolization(TACE) combined with percutaneous microwave ablation(MWA) after hepatectomy in Kailuan General Hospital from January 2016 to January 2018 were selected.According to whether the patients were associated with malnutrition risk, combined with the nutritional risk screening 2002 score(NRS2002),all patients were divided into observation group(49 cases)(total score ≥3 points) and control group(51 cases)(total score <3 points) followed up for more than 2 years, The liver function, pathological characteristics and 2-year survival rate were compared between the two groups.Kaplan Meier curve was used for survival analysis.Log rank test and Cox multivariate regression were used to analyze the influence of malnutrition risk and other factors on prognosis. Results:The proportion of tumor >5 cm and BCLC staging in the observation group were significantly higher than those in the control group(P<0.05).After operation, Alb and CHE in the observation group were significantly lower than those in the control group(P<0.05).AST,ALT and DBil levels in the observation group were significantly higher than those in the control group( P < 0. 05). The 2-year survivalrate of the observation group was significantly lower than that of the control group[65. 31%( 32/49) vs 82. 5%( 42/51),χ~2= 4. 439,P = 0. 035]. Univariate analysis showed that tumor size,BCLC stage,malnutrition risk,age,postoperative targeted drugs or combined with PD-1 were the factors influencing the prognosis of PLC patients. Further multivariate analysis showed that BCLC stage and malnutrition risk were the independent risk factors influencing the prognosis of PLC patients( P < 0. 05),and postoperative targeted drugs or combined with PD-1 were the protective factors influencing the prognosis of PLC patients factor( HR = 0. 823,95% CI =0. 753 ~ 0. 894). Conclusion: Malnutrition is an independent risk factor for the prognosis of PLC patients. PLC patients with malnutrition risk have more severe liver damage,faster tumor progression and worse prognosis after TACE combined with MWA.