基于乙肝表面抗原表达的973例早期肝细胞癌预后分析

Prognostic analysis based on expression of hepatitis B surface antigen in 973 patients with early hepatocellular carcinoma

目的 分析早期肝细胞癌(hepatocellular carcinoma,HCC)患者的病因及临床资料,探索病因和预后之间的关系。方法 回顾性分析2012年1月1日至2019年12月31日于首都医科大学附属北京佑安医院初次接受经肝动脉栓塞化疗(TACE)的973例早期HCC患者的临床及预后资料。描述肝癌患者病因谱,比较具有不同病因的患者的临床资料,并通过Kaplan-Meier曲线和Log-rank检验比较其无复发生存期(recurrence-free survival,RFS)和总生存期(overall survival,OS)的差异。结果 973例早期肝细胞癌患者中乙肝和丙肝病毒感染相关肝癌占97.2%(946/973),非病毒相关肝癌仅占2.8%(27/973)。在乙肝相关肝癌和联合感染相关肝癌患者中,有14.8%(140/946)为HBsAg阴性,联合感染患者中HBsAg阴性情况较乙肝相关肝癌更为常见[80.2%(77/96)和7.9%(63/798)]。截止随访时间2021年7月1日,无肝炎患者(n=63)和单纯乙肝病毒(hepatitis B virus,HBV)感染患者(n=735)总体RFS和OS无统计学差异(P>0.05);单纯丙肝病毒(hepatitis C virus,HCV)感染(n=19)以及乙肝和丙肝病毒联合感染的患者(n=77)总体RFS和OS方面也无统计学差异(P>0.05)。4种病因(HBV、HCV、联合感染和非病毒因素)的RFS无统计学差异,患者的中位RFS为2~3年;OS存在统计学差异:非病毒相关的肝癌患者累积OS最低,中位OS为55个月;其次为HCV相关肝癌,中位OS为69个月。结论 在早期肝癌患者中,病毒感染仍是肝癌发生的最主要因素,而HBsAg阳性感染占主导地位。即使患者HBsAg阴性,在接受治疗后也应该规律随访。而对于其他非病毒病因的患者,在癌变之前要加强肝癌的筛查,提高早期诊断率;癌变之后要加强随访,改善长期预后。

objective The etiology and clinical data of early hepatocellular carcinoma(HCC) patients were analyzed to explore the relationship between etiology and prognosis. Methods The clinical and prognostic data of 973 patients with early HCC treated with transcatheter arterial chemoembolization(TACE) in Beijing You’an Hospital, Capital Medical University from Jan. 1, 2012 to Dec. 31, 2019 were retrospectively analyzed. The etiological profiles of HCC patients were described and the clinical data of patients with different causes were compared, and the recurrence-free survival(RFS) and overall survival(OS) between groups were analyzed and compared by Kaplan-Meier curves and Log-rank test. Results Viral infection-related HCC accounted for 97.2%(946/973), while non-viral HCC accounted for only 2.8%(27/973). Among patients with HBV-and co-infectionassociated HCC, 14.8%(140/946) were HBsAg negative. HBsAg negative was more common in co-infected HCC patients than in HBV-associated HCC [80.2%(77/96) and 7.9%(63/798)]. As of Jul. 1, 2021, there was no statistical difference in RFS or OS between patients without hepatitis B virus(HBV) infection(n=63) and those with only HBV infection(n=735) or between patients with only hepatitis C virus(HCV) infection(n=19) and those with co-infection(n=77)(P>0.05). There was no statistical difference in cumulative RFS for the four etiologies(HBV, HCV, co-infection, and non-virus), and the median RFS was about 2-3 years. However, Patients with non-virus HCC had the worst cumulative OS, followed by patients with HCV-related HCC. The median OS was 55 months for non-virus-related HCC and 69 months for HCV-related HCC. Conclusion In patients with early HCC, viral infection was the most important factor, and positive HBsAg was still dominant. Patients should be regularly followed up after treatment even if HBsAg was negative. For patients with other no-viral causes, the screening of HCC should be strengthened before cancer to increase early diagnosis rate. Follow-up should be strengthened among these patients to improve long-term prognosis.