基于监测、流行病学和最终结果数据库的肝癌临床病理特征及预后分析  

Analysis of clinicopathological characteristics and prognosis of liver cancer based on search surveillance,epidemiology,and end result program database

作　　者：张云波[1] 李敬 刘俊启[3] 郑丽萍[2] 徐燕 张建光[1] ZHANG Yunbo;LI Jing;LIU Junqi;ZHENG Liping;XU Yan;ZHANG Jianguang(Department of Oncology,Zibo Wanjie Cancer Hospital,Zibo 255213,China;Department of Internal Medicine,Zibo Wanjie Cancer Hospital,Zibo 255213,China;Department of Radiotherapy,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Stereotactic Radiotherapy,Qingdao Central Hosptial,Qingdao 266042,China)

机构地区：[1]淄博万杰肿瘤医院肿瘤科,山东淄博255213 [2]淄博万杰肿瘤医院内科,山东淄博255213 [3]郑州大学第一附属医院放疗科,河南郑州450052 [4]青岛市中心医院肿瘤立体定向放疗科,山东青岛266042

出　　处：《肿瘤基础与临床》2023年第5期399-404,共6页journal of basic and clinical oncology

基　　金：国家重点研发计划项目(2018YFE0114100);国家自然科学基金资助项目(81703158)。

摘　　要：目的探讨肝细胞癌(HCC)和肝内胆管腺癌(ICC)患者临床病理特征对预后的影响。方法纳入监测、流行病学和最终结果数据库2010年至2015年病理确诊的肝癌患者19095例,统计患者2、3、5 a总生存率,并进行HCC、ICC预后影响因素的单因素和多因素分析。结果HCC组和ICC组2 a总生存率分别为44.5%和32.2%(P<0.001),3 a总生存率分别为35.6%和21.7%(P<0.001),5 a总生存率分别为34.6%和20.4%(P<0.001),中位生存时间分别为16个月和11个月。多因素COX回归模型分析显示,HCC组中性别(HR:1.074,95%CI:1.004~1.149,P=0.037)、年龄(HR:0.932,95%CI:0.879~0.988,P=0.019)、人种(HR:1.075,95%CI:1.012~1.142,P=0.018)、分化程度(HR:0.656,95%CI:0.608~0.707,P<0.001)、T分期(HR:0.787,95%CI:0.707~0.876,P<0.001)、N分期(HR:0.869,95%CI:0.790~0.956,P=0.004)、M分期(HR:0.656,95%CI:0.599~0.717,P<0.001)、临床分期(HR:0.636,95%CI:0.563~0.718,P<0.001)、手术(HR:4.461,95%CI:4.143~4.804,P<0.001)和化疗(HR:1.748,95%CI:1.649~1.853,P=0.019)均为独立预后影响因素。ICC组中性别(HR:1.329,95%CI:1.161~1.521,P<0.001)、年龄(HR:0.778,95%CI:0.666~0.909,P=0.002)、分化程度(HR:0.743,95%CI:0.634~0.776,P<0.001)、临床分期(HR:0.606,95%CI:0.474~0.776,P<0.001)、手术(HR:4.611,95%CI:3.856~5.515,P<0.001)和化疗(HR:2.002,95%CI:1.720~2.330,P<0.001)均为独立预后影响因素。结论ICC比HCC生存预后差,两者的预后影响因素存在差异,临床治疗应当分别对待。Objective To explore the influence of clinicopathological characteristics on prognosis of patients with hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(ICC).Methods In surveillance,epidemiology,and end result program database from 2010 to 2015,a total of 19095 patients with liver cancer were diagnosed pathologically.The 2-year,3-year and 5-year overall survival rates were calculated.Prognosis factors were evaluated by using univariate factor and multivariate analysis.Results The 2-year overall survival rates of the HCC group and the ICC group were 44.5%and 32.2%,respectively(P<0.001);the 3-year overall survival rates of the two group were 35.6%and 21.7%,respectively(P<0.001);the 5-year overall survival rates of the two group were 34.6%and 20.4%,respectively(P<0.001);the median overall survival were 16 and 11 months.Multivariate COX regression analysis showed that gender(HR:1.074,95%CI:1.004-1.149,P=0.037)、age(HR:0.932,95%CI:0.879-0.988,P=0.019)、race(HR:1.075,95%CI:1.012-1.142,P=0.018)、degree of differentiation(HR:0.656,95%CI:0.608-0.707,P<0.001)、T stage(HR:0.787,95%CI:0.707-0.876,P<0.001)、N stage(HR:0.869,95%CI:0.790-0.956,P=0.004)、M stage(HR:0.656,95%CI:0.599-0.717,P<0.001)、clinical stage(HR:0.636,95%CI:0.563-0.718,P<0.001)、operation(HR:4.461,95%CI:4.143-4.804,P<0.001)and chemotherapy(HR:1.748,95%CI:1.649-1.853,P=0.019)in the HCC group was the prognostic factors;while the gender(HR:1.329,95%CI:1.161-1.521,P<0.001),age(HR:0.778,95%CI:0.666-0.909,P=0.002),degree of differentiation(HR:0.743,95%CI:0.634-0.776,P<0.001),clinical stage(HR:0.606,95%CI:0.474-0.776,P<0.001),operation(HR:4.611,95%CI:3.856-5.515,P<0.001)and chemotherapy(HR:2.002,95%CI:1.720-2.330,P<0.001)in the ICC group were the prognostic factors.Conclusion The prognosis of ICC is worse than HCC,the prognostic factors of HCC and ICC are different,clinical treatment should be treated separately.

关 键 词：肝细胞癌 肝内胆管腺癌 预后 

分 类 号：R735.7[医药卫生—肿瘤]