超声筛查频率与肝细胞癌患者病死率相关性分析  

Association between ultrasound screening frequency and mortality in patients with hepatocellular carcinoma

作　　者：宋晶晶[1] 卢伟业[2] 赵中伟[1] 范晓希[1] 涂建飞[1] 纪建松[1] 

机构地区：[1]温州医科大学附属第五医院丽水市中心医院介入诊疗中心,浙江丽水323000 [2]温州医科大学附属第五医院丽水市中心医院超声科,浙江丽水323000

出　　处：《中华医学杂志》2016年第45期3652-3655,共4页National Medical Journal of China

基　　金：国家自然科学基金面上项目（81573657）;浙江省重大科技专项重大社会发展项目（2013C03010）;浙江省自然科学青年基金（Q17H180002）;浙江省丽水市科技计划项目（2012JYZB89）

摘　　要：目的 探讨肝细胞癌（HCC）患者确诊前行超声筛查频率与其总病死率的相关性，以明确HCC高危人群最佳超声筛查频率。方法 回顾性收集2010年1月1日至2015年12月31日丽水市中心医院615例乙肝后肝硬化发展为HCC患者的临床资料，根据患者确诊HCC之前接受超声筛查的频率，分为5组：0～6个月组，7～12个月组，13～24个月组，25～36个月组，3年内未做超声筛查组（未筛查组）。分析各组患者接受根治性治疗的比例、5年总病死率及病死率的独立影响因素。结果 615例HCC患者中，0～6个月组，7～12个月组，13～24个月组，25～36个月组及未筛查组接受根治性治疗的比例分别为38.2%、27.2%、25.4%、23.8%和19.7% （P〈0.05），各组5年总病死率分别为76.4%、77.7%、79.3%、82.5%和84.6%，与0～6个月组相比，其他各组调整后OR值分别为1.112、1.235、1.305和1.451 （均P〈0.05）。多元分析结果显示，超声筛查频率、根治性治疗及Child－Pugh分级（A/B级）是影响HCC患者远期生存的因素（均P〈0.05）。结论 HCC高危人群最佳的超声筛查频率是6个月以内，高频率的超声筛查可增加HCC高危人群接受根治性治疗的机会，降低总病死率，提高总生存期。Objective To discuss the association between ultrasound screening frequency and total mortality in patients with HCC before diagnosing HCC, and explore the optimal ultrasound screening frequency for HCC high-risk groups.Methods Retrospectively collected clinical data of 615 cases of liver cirrhosis who developed to HCC from January 1, 2010 to December 31, 2015. Before diagnosing HCC, all patients were divided into five groups according to ultrasound screening frequency： 0-6, 7-12, 13-24, 25-36 months and not screened within 3 years （never screened）. The chance to receive curative therapy, 5-year cumulative mortalities and independent factors of mortality in patients with HCC were analyzed.Results Chances to receive curative therapy among the 0-6, 7-12, 13-24, 25-36 months and never screened groups were 38.2%, 27.2%, 25.4%, 23.8% and 19.7%, respectively （P〈0.05）. The 5-year overall mortality rates were 76.4%, 77.7%, 79.3%, 82.5% and 84.6%, respectively. Compared with 0-6 months, the adjusted OR of mortality for the other groups were 1.112, 1.235, 1.305 and 1.451, respectively （all P〈0.05）. Multivariate analysis showed that ultrasound screening frequency, curative treatment and Child-Pugh （class A/B） were the factors to affect long-term survival in patients with HCC （all P〈0.05）.Conclusion For HCC high-risk groups, optimal ultrasound screening frequency is within 6 months, and high-frequency ultrasound screening can increase the chance of receiving curative treatment, reduce total mortality, and improve overall survival.

关 键 词：超声检查 癌 肝细胞 死亡率 

分 类 号：R735.7[医药卫生—肿瘤]