非HBV和HCV相关性肝细胞癌患者临床特征及预后影响因素分析  

An analysis of clinical characteristics and prognostic factors of patients with non-HBV and non-HCV related hepatocellular carcinoma

作　　者：苏丹[1] 张伟伟 SU Dan;ZHANG Wei-wei(Department of Oncology,the Third Medical Center of PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第三医学中心肿瘤科,北京100039

出　　处：《肝脏》2021年第4期384-387,共4页Chinese Hepatology

基　　金：国家自然科学基金(81372595)。

摘　　要：目的了解非HBV、HCV相关性肝细胞癌(NBNC-HCC)的临床特征及预后。方法2010年1月至2017年6月解放军总医院第三医学中心收治的HCC患者94例。其中血清HBsAg、抗-HCV均为阴性HCC患者26例(NBNC-HCC组);血清HBsAg或抗-HCV为阳性HCC患者68例(非NBNC-HCC组)。多因素Logistic回归分析NBNC-HCC发生的影响因素。结果NBNC-HCC组患者年龄(69.7±12.3)岁,非NBNC-HCC组年龄(62.4±8.3)岁,差异有统计学意义(t=12.40,P<0.05);NBNC-HCC组患者AFP 90.5(65.8,234.0)ng/mL,非NBNC-HCC组AFP 219.5(95.0,318.3)ng/mL,差异有统计学意义(Z=13.83,P<0.05);NBNC-HCC组患者ALT(26.6±14.7)U/L,非NBNC-HCC组ALT(38.5±1.7)U/L,差异有统计学意义(t=5.41,P<0.05);NBNC-HCC组患者Child-Pugh A级23例(88.5%),Child-Pugh B级3例(11.5%),非NBNC-HCC组患者Child-Pugh A级46例(67.6%),Child-Pugh B级22例(32.4%),差异有统计学意义(χ^(2)=4.17,P<0.05);NBNC-HCC组患者有血管侵犯3例(11.5%),无血管侵犯23例(88.5%);非NBNC-HCC组患者有血管侵犯29例(42.6%),无血管侵犯39例(57.4%),差异有统计学意义(χ^(2)=8.11,P<0.05);NBNC-HCC组患者肿瘤边界界清17例(65.4%),肿瘤边界界不清9例(34.6%);非NBNC-HCC组患者肿瘤边界界清17例(25.0%),肿瘤边界界不清51例(75.0%),差异有统计学意义(χ^(2)=13.29,P<0.05);NBNC-HCC组患者有肿瘤包膜22例(84.6%),无肿瘤包膜4例(15.4%);非NBNC-HCC组患者有肿瘤包膜32例(47.1%),无肿瘤包膜36例(52.9%),差异有统计学意义(χ^(2)=10.85,P<0.05)。多因素logistic回归分析得出AFP、Child-Pugh分级、血管侵犯、肿瘤边界及肿瘤包膜是NBNC-HCC发生的独立危险因素。结论AFP、Child-Pugh分级、血管侵犯、肿瘤边界及肿瘤包膜是影响NBNC-HCC发生的独立危险因素。Objective The clinical features and prognostic data of non-hepatitis B and non-hepatitis C related hepatocellular carcinoma(NBNC-HCC)were retrospectively analyzed in order to provide references for the treatment strategies on NBNC-HCC patients.Methods A total of 94 patients(69 males and 25 females)with HCC were collected from January 2010 to June 2017,with an average age of 65.3±9.6 years.Twenty-six patients that were negative in serum HBsAg and HCV antibody(Ab)were grouped in NBNC-HCC group,including 19 males and 7 females.Sixty-eight patients that were positive in serum HBsAg or HCV Ab were grouped in non-NBNC-HCC group,with 50 males and 18 females.Multivariate Logistic regression analysis was used to explore the influencing factors of NBNC-HCC.Results The clinical data of NBNC-HCC group and non-NBNC-HCC group were compared.The average age of patients in NBNC-HCC group was(69.7±12.3)years old,while that in non-NBNC-HCC group was(62.4±8.3)years old.The difference was statistically significant(P<0.05).The alpha-fetoprotein(AFP)level in the patients of NBNC-HCC group 90.5(65.8,234.0)ng/mL were significant lower than that of the non-NBNC-HCC group 219.5(95.0,318.3)ng/mL(P<0.05).The ALT level in NBNC-HCC group(26.6±14.7)U/L were also different with that of the non-NBNC-HCC group(38.5±1.7)U/L(P<0.05).In NBNC-HCC group,23 patients(88.5%)were Child-Pugh grade A,3 patients(11.5%)were Child-Pugh grade B,while in NBNC-HCC group,46 patients(67.6%)were Child-Pugh grade A,and 22 patients(32.4%)were Child-Pugh B,the difference was statistically significant(P<0.05).In NBNC-HCC group,there were 3 cases(11.5%)with vascular invasion and 23 cases(88.5%)without vascular invasion,while in non-NBNC-HCC group,there were 29 cases(42.6%)with vascular invasion and 39 cases(57.4%)without vascular invasion,the difference was statistically significant(P<0.05).In NBNC-HCC group,tumor boundary was clear in 17 cases(65.4%)and unclear in 9 cases(34.6%),while in non-NBNC-HCC group,tumor boundary was clear in 17 cases(25.0%)and unclear in 51

关 键 词：非HBV、HCV相关性肝细胞癌 AFP CHILD-PUGH分级 Logistic回归分析 

分 类 号：R73[医药卫生—肿瘤]