非乙非丙型肝癌与HBV/HCV相关肝癌的临床特点及预后影响因素分析  

Clinical features of non- B non- C hepatocellular carcinoma and virus-associated hepatocellular carcinoma and re-lated prognostic factors

作　　者：黄宇[1] 黄迪[1,2] 刘硕[1,2] 翁杰锋[1,2] 张帅[1,2] 张强[1] 麦振豪 古维立[1,2] 

机构地区：[1]广州医科大学附属广州市第一人民医院肝胆外科,广州510180 [2]广州消化疾病中心,广州510180

出　　处：《临床肝胆病杂志》2016年第3期514-517,共4页Journal of Clinical Hepatology

基　　金：广东省科技计划项目(2011B061300024;2013B021800057);广东省自然基金项目(10151006001000013);广州市医药卫生科技一般引导项目(20131A011029;20141A01003);广州市科技和信息化局科普专项项目(2014KP000086)

摘　　要：目的探讨非乙非丙型肝癌（NBNC-HCC）与HBV/HCV相关肝癌（BC-HCC）患者的临床特点的不同及二者的预后影响因素。方法收集1999年1月1日-2014年7月1日于广州市第一人民医院行肝部分切除术的原发性肝癌患者231例,排除失访和不愿配合者,最终入组146例。分为NBNC-HCC组（n=35）和BC-HCC组（n=111）。收集患者临床资料,随访患者生存情况、复发时间和死亡时间。计数资料组间比较采用χ2检验,计量资料组间比较采用t检验。两组生存率的比较采用Log-Rank检验,单因素及生存分析采用Kaplan-Meier检验,多因素采用Cox比例风险回归分析模型。结果 NBNC-HCC组患者年龄、TNM分期中Ⅰ~Ⅱ期比例比BC-HCC组高（t=3.878,P〈0.05;χ2=4.357,P〈0.05）,术前甲胎蛋白（AFP）水平低于BC-HCC组（t=7.848,P〈0.05）;NBNC-HCC组和BC-HCC组平均生存时间分别为（35.5±27.9）个月和（26.8±21.7）个月,NBNC-HCC组与BC-HCC组3年生存率（61.6%vs 26.6%）和5年生存率（39.2%vs 14.1%）比较,差异均有统计学意义（P值均〈0.05）;影响NBNC-HCC组预后的独立危险因素是Alb水平[RR=0.919,95%可信区间（95%CI）：0.851~0.994,P=0.036;影响BC-HCC组预后的独立危险因素是肿瘤直径（RR=1.082,95%CI：1.027~1.141,P=0.003）。结论 NBNC-HCC与BC-HCC在年龄、AFP值和TNM分期上存在差异。NBNC-HCC患者3、5年生存率高于BC-HCC患者。Alb水平是影响NBNC-HCC预后的独立危险因素,肿瘤直径是影响BC-HCC预后的独立危险因素。Objective To investigate the differences in the clinical features of non- B,non- C hepatocellular carcinoma（ NBNC- HCC）and virus- associated hepatocellular carcinoma（ BC- HCC） and related prognostic factors. Methods A total of 231 patients with primary liver cancer who underwent partial hepatectomy in Guangzhou First People’s Hospital from January 1,1999 to July 1,2014 were selected,and those who were lost to follow- up and unwilling to cooperate were excluded; 146 patients were finally enrolled,and were divided into NBNC- HCC group（ 35 patients） and BC- HCC group（ 111 patients）. The patients’ clinical data were collected,and the patients were followed up to record their survival,time to recurrence,and death time. The chi- square test was applied for comparison of categorical data between groups,and the t- test was applied for comparison of continuous data between groups. The log- rank test was applied for comparison of survival rates,the Kaplan- Meier method was applied for univariate analysis and survival analysis,and the Cox proportional hazards regression model was applied for multivariate analysis. Results Compared with the BC- HCC group,the NBNC- HCC group had a significantly higher mean age and a significantly higher proportion of patients in TNM stage Ⅰ- Ⅱ（ t = 3. 878,P 〈 0. 05; χ2= 4. 357,P 〈 0. 05）,as well as a significantly lower preoperative level of alpha- fetoprotein（ AFP）（ t = 7. 848,P 〈 0. 05）. The mean survival time for the NBNC- HCC group and the BC- HCC group was 35. 5 ± 27. 9 months and 26. 8 ± 21. 7 months,respectively,and there were significant differences in the 3- and 5- year survival rates between the NBNC- HCC group and the BC- HCC group（ 61. 6% vs 26. 6%,39. 2% vs14. 1%,both P 〈 0. 05）. Multivariate analysis showed that albumin（ Alb） level was the independent prognostic factor for the NBNC- HCC group（ RR = 0. 919,95% CI： 0. 851- 0. 994; P = 0. 036）; the diameter of tumor was the independent prognostic factor for the BC- HCC gr

关 键 词：肝肿瘤 治疗效果 预后 危险因素 

分 类 号：R735.7[医药卫生—肿瘤]