279例老年原发性肝癌临床特点及预后影响因素分析  

Analysis of the clinical characteristics of primary liver cancer and the influencing factors of prognosis

作　　者：王华利[1] 熊清芳[1] 杨永峰[1] 

机构地区：[1]南京市第二医院肝病113区,江苏省南京市210003

出　　处：《实用老年医学》2017年第12期1135-1137,共3页Practical Geriatrics

摘　　要：目的分析老年原发性肝癌(primary liver cancer,PLC)的病因及临床特点,探讨影响其预后的因素。方法选择2006年1~12月诊断为PLC的老年病人279例,回顾性分析其性别、年龄,有无肝硬化、门静脉栓子、脾功能亢进、肝内转移,甲胎蛋白(α-fetoprotein,AFP)水平及治疗方式,分析影响老年PLC预后的因素。结果性别、年龄及有无肝硬化对老年PLC病人生存率无显著影响(P>0.05)。存活6月、12月、36月、60月老年PLC病人间是否合并门静脉栓子、肝内转移、脾功能亢进及AFP水平差异具有统计学意义(P<0.05);采用综合治疗、介入治疗、微波治疗与保守治疗的老年PLC病人6月、12月、36月、60月的生存率差异有统计学意义(P<0.05),介入治疗和微波治疗组间差异无统计学意义(P>0.05)。结论 HBV感染为老年PLC病人发病的主要原因,肝硬化为老年PLC病人发病的主要病理基础,发生门静脉栓子、肝内转移,存在脾功能亢进等均为影响老年PLC病人预后的独立危险因素,AFP作为诊断及判断PLC预后的主要血清标志,仍具有一定的临床价值,介入、微波治疗和综合治疗可获得同等的效果,均能提高病人生存率。Objective To analyze the pathogeny and clinical characteristics of primary liver cancer（ PLC） in the elderly patients and to discuss the factors affecting the prognosis. Methods The clinical data of 279 cases of elderly patients with PLC from January 2006 to December 2016 were retrospectively analyzed,including gender,age,alpha-fetoprotein（ AFP） level,treatment method,liver cirrhosis,portal vein thrombosis,hypersplenism and liver metastasis. The influencing factors of prognosis were analyzed. Results Gender and age showed no significant effects on survival rate in the elderly patients with PLC（ P 0. 05）. Cox regression analysis showed that portal vein thrombosis,liver metastasis,and hypersplenism and alpha-fetoprotein level are independent risk factors（ P 0. 05）.There was significant difference between comprehensive treatment and interventional therapy,microwave therapy and conservative treatment in the survival rate of elderly patients with PLC in the treatment of 6 months,12 months,36 months and 60 months（ P 0. 05）,and there was no significant difference between interventional therapy and microwave therapy（ P 0. 05）. Conclusions HBV infection is the main pathogery of PLC in elderly patients. Liver cirrhosis is the main pathological basis of the pathogenesis of PLC in elderly patients. Portal vein thrombus,liver metastasis and hypersplenism are independent risk factors affecting prognosis of elderly patients with PLC. AFP is the main serum marker of diagnosis and judgment of PLC prognosis. There is still a certain clinical value. Intervention,microwave therapy and comprehensive treatment can have the same effect in improving the survival rate of patients.

关 键 词：老年人 原发性肝癌 预后 甲胎蛋白 

分 类 号：R735.3[医药卫生—肿瘤]