原发性肝癌患者临床特征、细胞形态学分析及其预后的影响因素分析

Analysis of clinical features,cell morphology and prognostic factors in patients with primary liver cancer

目的探讨原发性肝癌患者临床特征、细胞形态学分析及其预后影响因素分析。方法前瞻性选取2019年3月至2022年3月榆林市第二医院收治的100例原发性肝癌患者作为研究对象,对患者进行为期18个月的随访,根据随访生存情况将其分为生存组(n=81)和死亡组(n=19)。收集两组临床资料,测定胆碱酯酶、直接胆红素(DBil)、白蛋白、间接胆红素(IBil)、丙氨酸转移酶(ALT)、天冬氨酸转移酶(AST)水平,分析细胞形态,采用Logistics回归模型分析原发性肝癌预后的影响因素。结果两组性别、年龄、体重指数、吸烟史、饮酒史、病理组织类型、Child-Pugh分级、门静脉癌栓、术后靶向药物或联合PD-1比较,差异均无统计学意义(P>0.05);生存组肿瘤大小中>5 cm、BCLC分期中C级的患者比例分别为37.04%、13.58%,均低于死亡组(63.16%、36.84%),差异均有统计学意义(P<0.05)。生存组患者胆碱酯酶、DBil、白蛋白、IBil、ALT、AST水平分别为(3056.38±198.76)U/L、(15.43±3.31)μmol/L、(43.98±5.07)g/L、(15.87±2.29)μmol/L、(44.39±6.91)U/L、(39.76±6.04)U/L,均低于死亡组[(3169.87±203.87)U/L、(17.46±4.14)μmol/L、(46.67±5.57)g/L、(17.18±2.45)μmol/L、(49.03±7.02)U/L、(42.87±6.13)U/L],差异均有统计学意义(P<0.05)。生存组患者红细胞异常、空泡样变性比例分别为9.88%、23.46%,均低于死亡组(47.37%、26.32%),核右移、核左移比例分别为27.16%、39.51%,均高于死亡组(10.53%、15.78%),差异均有统计学意义(P<0.05)。多因素Logistics回归分析结果显示,肿瘤大小、BCLC分期、红细胞异常、空泡样变性、核右移、核左移是原发性肝癌患者预后的影响因素(P<0.05)。结论生存原发性肝癌患者中临床特征为肿瘤>5 cm,BCLC分期中C级的病例较少,细胞形态呈核右移、核左移较多,红细胞异常、空泡样变性则较少,其预后影响因素为瘤大小、BCLC分期、红细胞异常、空泡样变性、核右移、核左移。

Objective To investigate the clinical features,cell morphology and prognostic factors of patients with primary liver cancer.Methods A total of 100 patients with primary liver cancer admitted to Yulin No.2 Hospital from March 2019 to March 2022 were prospectively selected as the study objects.The patients were followed up for 18 months,and were divided into survival group(n=81)and death group(n=19)according to the follow-up survival.Clinical data of the two groups were collected,and cholinesterase,direct bilirubin(DBil),albumin,indirect bilirubin(IBil)and alanine aminotransferase(ALT),aspartate aminotransferase(AST)levels were determined.Cell morphology was analyzed.Logistics regression model was used to analyze the prognostic factors of primary liver cancer.Results The sex,age,body mass index,smoking history,drinking history,pathological tissue type,Child-Pugh grade,portal vein cancer thrombus,postoperative targeted drugs or combined PD-1 were compared between the two groups(P>0.05).The rates of patients with tumor size>5 cm in the survival group and grade C in the BCLC stage were 37.04%and 13.58%,respectively,which were lower than those in the death group(63.16% and 36.84%),and the differences were statistically significant(P<0.05).The levels of cholinesterase,DBil,albumin,IBIl,ALT,and AST in the survival group patients were(3056.38±198.76)U/L,(15.43±3.31)μmol/L,(43.98±5.07)g/L,(15.87±2.29)μmol/L,(44.39±6.91)U/L,and(39.76±6.04)U/L,respectively,which were lower than those in the death group[(3169.87±203.87)U/L,(17.46±4.14)]μmol/L,[(46.67±5.57)g/L,(17.18±2.45)μmol/L,(49.03±7.02)U/L,(42.87±6.13)U/L],the differences were statistically significant(P<0.05).erythrocyte abnormality,vacuole-like degeneration,right shift and left shift were statistically significant in survival group compared with death group(P<0.05).The rates of erythrocyte abnormality,vacuole-like degeneration in the survival group were 9.88%and 23.46%,respectively,which were lower than those in the death group(47.37%and 26.32%),the rates of nuclear right shift and nuclear left shift were 27.16%and 39.51%,respectively,which were higher than those in the death group(10.53%and 15.78%),and the differences were statistically significant(P<0.05).The results of multivariate Logistic regression analysis showed that tumor size,BCLC stage,red blood cell abnormalities,vacuolar degeneration,nuclear rightward shift,and nuclear leftward shift were prognostic factors for primary liver cancer patients(P<0.05).Conclusion The clinical characteristics of surviving primary liver cancer patients are tumors>5 cm,and there are few cases in grade C BCLC stage,with more dextral and leftral nuclear metastasis in cell morphology,and fewer erythrocyte abnormalities and vacuole-like degeneration.The prognostic factors are tumor size,BCLC stage,erythrocyte abnormalities,vacuole-like degeneration,dextral and leftral nuclear metastasis.