850例单中心肝细胞癌患者的临床特征与预后分析

Clinical features and prognosis of hepatocellular carcinoma:A single-center study of 850 cases

目的探讨肝细胞癌(HCC)的临床特征及其预后。方法收集2014年12月—2022年5月湖北省中医院收治的850例HCC患者病历资料,分析其临床及预后特征。计数资料组间比较采用χ^(2)检验,Kaplan-Meier计算生存时间和生存率,Log-rank检验比较基线特征的生存期差异。结果850例HCC患者,以男性为主(82.6%),首诊中位年龄58.0(49.0~66.0)岁,50~69岁年龄段占比最高(59.8%)。HBV感染占比最高(77.4%),首诊74.2%患者合并肝硬化,49.2%有门静脉癌栓,20.2%肝外转移,以肺部转移占比最高(44.2%,76/172)。巴塞罗那分期(BCLC)A(0)、B、C、D期分别为20.4%、22.5%、41.5%、15.6%。患者性别(χ^(2)=16.631,P=0.001)、年龄段(χ^(2)=24.261,P=0.019)、居住地(χ^(2)=39.776,P<0.001)、是否有病毒性肝炎(χ^(2)=8.338,P=0.040)、首诊前是否规律抗病毒(χ^(2)=26.140,P<0.001)的BCLC分期总体分布差异均有统计学意义。随访到489例患者的生存时间,总体中位生存时间19.99个月(95%CI:14.86~25.12),1、3、5、10年总体累积生存率分别为60.7%、39.9%、29.4%、22.7%。不同年龄段(χ·2=13.452,P=0.009)、病毒性肝炎病史(χ^(2)=6.123,P=0.013)、首诊前是否规律抗病毒(χ^(2)=15.505,P<0.001)、合并2型糖尿病(χ^(2)=9.820,P=0.002)、肿瘤个数(χ^(2)=57.713,P<0.001)、肿瘤最大直径(χ^(2)=41.862,P<0.001)、门静脉癌栓(χ^(2)=293.909,P<0.001)、首诊肝外转移(χ^(2)=118.329,P<0.001)、BCLC分期(χ^(2)=465.638,P<0.001)、手术切除(χ^(2)=78.860,P<0.001)、局部治疗(χ^(2)=36.216,P<0.001)、免疫检查点抑制剂和/或抗肿瘤血管生成治疗(χ^(2)=7.182,P=0.007)、中药汤剂治疗(χ^(2)=30.050,P<0.001)、不同综合治疗方案(χ^(2)=13.221,P=0.004)的生存时间有差异。259例(30.5%)患者记录了无进展生存期,无进展中位生存时间为10.98个月(95%CI:8.54~13.42)。结论HCC患者在性别、年龄、居住地、是否有病毒性肝炎、首诊前规律抗病毒、肿瘤特征、治疗方式、预后均存在流行病学特征,早期发现率低、总体生存时间短,急需开展早筛、早诊、早治工作。

Objective To investigate the clinical features and prognosis of hepatocellular carcinoma(HCC).Methods Medical records were collected from 850 HCC patients who were admitted to Hubei Provincial Hospital of Traditional Chinese Medicine from December 2014 to May 2022,and their clinical and prognostic features were analyzed.The chi-square test were used for comparison of categorical data between groups;the Kaplan-Meier method was used to calculate survival time and survival rate,and the log-rank test was used for comparison of survival time based on baseline features.Results Among the 850 HCC patients,male patients accounted for 82.6%,and the median age at initial diagnosis was 58.0(49.0,66.0)years,with the highest proportion of patients aged 50—69 years(59.8%).The patients with HBV infection accounted for the highest proportion of 77.4%;at initial diagnosis,49.2%of the patients had portal vein tumor thrombus,and 20.2%of the patients had extrahepatic metastasis,among which pulmonary metastasis accounted for the highest proportion of 44.2%(76/172).The patients with Barcelona Clinic Liver Cancer(BCLC)stage A(0),B,C,and D HCC accounted for 20.4%,22.5%,41.5%,and 15.6%,respectively.There was a significant difference in the distribution of BCLC stages between different groups based on sex(χ^(2)=16.631,P=0.001),age(χ^(2)=24.261,P=0.019),place of residence(χ^(2)=39.776,P<0.001),presence or absence of viral hepatitis(χ^(2)=8.338,P=0.040),and presence or absence of regular antiviral therapy before initial diagnosis(χ^(2)=26.140,P<0.001).Follow-up was performed for 489 patients till death,with a median survival time of 19.99 months(95%confidence interval[CI]:14.86—25.12),and the 1-,3-,5-,and 10-year cumulative survival rates were 60.7%,39.9%,29.4%,and 22.7%,respectively.There was a significant difference in survival time between different groups based on age(χ^(2)=13.452,P=0.009),history of viral hepatitis(χ^(2)=6.123,P=0.013),regular antiviral therapy before initial diagnosis(χ^(2)=15.505,P<0.001),comorbidity with type 2 diabetes(χ^(2)=9.820,P=0.002),the number of tumors(χ^(2)=57.713,P<0.001),maximum tumor diameter(χ^(2)=41.862,P<0.001),portal vein tumor thrombus(χ^(2)=293.909,P<0.001),extrahepatic metastasis at initial diagnosis(χ^(2)=118.329,P<0.001),BCLC stage(χ^(2)=465.638,P<0.001),surgical resection(χ^(2)=78.86,P<0.001),local treatment(χ^(2)=36.216,P<0.001),immune checkpoint inhibitor treatment and/or anti-tumor angiogenesis therapy(χ^(2)=7.182,P=0.007),traditional Chinese medicine decoction treatment(χ^(2)=30.050,P<0.001),and comprehensive treatment regimens(χ^(2)=13.221,P=0.004).Progression-free survival(PFS)was recorded for 259 patients(30.5%),with a median PFS of 10.98 months(95%CI:8.54—13.42).Conclusion HCC patients exhibit epidemiological characteristics in terms of sex,age,place of residence,presence or absence of viral hepatitis,regular antiviral therapy before initial diagnosis,tumor characteristics,treatment modality,and prognosis,with a low early detection rate and a short overall survival time,and therefore,it is urgent to perform early screening,early diagnosis,and early treatment.