乙型肝炎病毒相关肝细胞癌患者临床特征及生存分析(2018—2020年)

Clinical characteristics and survival of patients with hepatitis B virus related hepatocellular carcinoma (2018-2020)

目的探讨2018—2020年HBV相关HCC患者的临床特征及多种抗肿瘤治疗后生存结局。方法回顾性分析2018—2020年在新疆医科大学第一附属医院就诊的396例HBV相关HCC患者, 收集患者首次确诊时一般资料、实验室指标、影像学检查、治疗方案等临床资料。随访所有患者, 根据患者生存结局分为生存组与死亡组。比较两组患者的临床特征, 探讨影响HBV相关HCC患者生存的因素。结果 HBV相关HCC患者以男性为主(81.1%, 321/396), 确诊HCC年龄多在30~59岁, 多有吸烟史, 合并肥胖居多, 以"HBeAg阴性慢性HBV感染"者多见(45.7%, 181/396)。中国肝癌分期方案(China liver cancer staging, CNLC)Ⅱb期~Ⅳ期HCC患者占74.5%(295/396), 失代偿期者占54.5%(216/396), 其中并发自发性腹膜炎最多(51.5%, 204/396)。患者行肝切除术、射频消融术、肝动脉灌注化疗栓塞术(transcatheter arterial chemoembolization, TACE)治疗、肝移植术、分子靶向药物治疗、免疫抑制剂治疗和中成药治疗的占比分别为12.4%(49/396)、11.4%(45/396)、28.5%(113/396)、0.5%(2/396)、23.2%(92/396)、4.0%(16/396)和11.6%(46/396)。所有患者平均生存时间(17.79±18.62)个月, 中位生存时间9个月, 随访满5年内的病死率为93.0%(106/114)。多因素Cox回归分析显示, 肝性脑病(HR=1.725, 95%CI: 1.030~2.891)、AFP(HR=1.001, 95%CI: 1.001~1.002)、FIB-4指数(HR=1.006, 95%CI: 1.000~1.012)、CNLCⅡb期(HR=3.440, 95%CI: 2.017~5.867)、CNLCⅢa期(HR=6.513, 95%CI: 3.396~12.489)、CNLCⅢb期(HR=5.656, 95%CI: 2.766~11.566)、CNLCⅣ期(HR=3.093, 95%CI: 1.359~7.040)是影响HBV相关HCC患者生存的独立危险因素。行TACE治疗是影响HBV相关HCC患者生存的保护因素(HR=0.628, 95%CI: 0.476~0.828)。采用Kaplan-Meier曲线分析确诊HCC前抗病毒与确诊HCC后抗病毒两组患者生存情况, 发现两组间生存率差异无统计学意义(P=0.342)。结论 2018—2020年HBV相关HCC患者以中老年男性居多, 多数患者确诊时肿瘤已处于中晚期, 且肝功能为失代偿期, 虽然接受多种抗肿瘤治疗, 但患者5年内生存率仍很低。患者并发肝性脑病时死亡风险高, 行TACE治疗可以改善预后。确诊肝癌前患者抗HBV治疗率较低, 与此部分患者比, 确诊后抗病毒治疗者未显示改善患者5年生存。

Objective:To investigate the clinical features and survival outcomes of patients with HBV-related HCC after multiple anti-tumor treatments from 2018 to 2020.Methods:A retrospective analysis was conducted on 396 patients with HBV-related HCC in the First Affiliated Hospital of Xinjiang Medical University from 2018 to 2020.Clinical data,including general information,laboratory indicators,imaging examinations and treatment protocols were collected at the time of initial diagnosis.All patients were followed up and divided into survival group and death group according to their survival outcomes.Clinical characteristics between the two groups were compared to explore factors affecting the survival of HBV-related HCC patients.Results:The majority of HBV-related HCC patients were males(81.1%,321/396),with the age mainly between 30 and 59 years.Most had a history of smoking and obesity,with HBeAg-negative chronic HBV infection being the most common type(45.7%,181/396).Patients diagnosed with China liver cancer staging(CNLC)Ⅱb toⅣaccounted for 74.5%(295/396),and those in decompensated liver function accounted for 54.5%(216/396),with spontaneous peritonitis being the most common complication(51.5%,204/396).The proportions of patients undergoing hepatectomy,radiofrequency ablation,transcatheter arterial chemoembolization(TACE)treatment,liver transplantation,molecular targeted drug therapy,immunosuppressive agents and traditional Chinese medicine treatment were 12.4%(49/396),11.4%(45/396),28.5%(113/396),0.5%(2/396),23.2%(92/396),4.0%(16/396)and 11.6%(46/396),respectively.The average survival time for all patients was(17.79±18.62)months,with a median survival time of 9 months.The mortality rate during the 5-year follow-up was 93.0%(106/114).Multivariate Cox regression analysis revealed that hepatic encephalopathy(HR=1.725,95%CI:1.030-2.891),AFP levels(HR=1.001,95%CI:1.001-1.002),FIB-4 index(HR=1.006,95%CI:1.000-1.012),CNLC stageⅡb(HR=3.440,95%CI:2.017-5.867),CNLC stageⅢa(HR=6.513,95%CI:3.396-12.489),CNLC stageⅢb(HR=5.656,95%CI:2.766-11.566),and CNLC stageⅣ(HR=3.093,95%CI:1.359-7.040)were independent risk factors affecting survival in HBV-related HCC patients.TACE treatment was identified as a protective factor for survival in HBV-related HCC patients(HR=0.628,95%CI:0.476-0.828).Kaplan-Meier curve analysis showed no statistically significant difference in survival rates between patients receiving antiviral treatment before and after HCC diagnosis(P=0.342).Conclusions:From 2018 to 2020,the majority of HBV-related HCC patients were middle-aged and elderly men,with most presenting at an intermediate to advanced stage of cancer and decompensated liver function.Despite receiving various anti-tumor therapies,the 5-year survival rate of patients remains low.The presence of hepatic encephalopathy significantly increases mortality risk,while TACE treatment can improve the prognosis.The rate of anti-HBV therapy prior to HCC diagnosis is low,and antiviral therapy dose not show improvement in 5-year survival of patients after diagnosis.