我国肝癌“临床相”30年的变迁——原发性肝癌3250例的对比研究  

Changes of clinical aspect of primary liver cancer in China during the past 30 Years -- control study for 3250 cases with primary liver cancer

作　　者：杨秉辉[1] 夏景林[1] 黄力文[1] 汤钊猷[1] 陈敏山[2] 李锦清[2] 梁安民[3] 莫钦国[3] 卢辉山[4] 戴朝六[5] 严律南[6] 于志坚[7] 饶荣生[8] 黎乐群[9] 苏智雄[9] 方壮伟[10] 

机构地区：[1]复旦大学附属中山医院复旦大学肝癌研究所 [2]中山大学医学院附属肿瘤医院 [3]广西医科大学附属肿瘤医院 [4]福建医科大学附属协和医院 [5]中国医科大学第二附属医院 [6]四川大学华西医院 [7]南通医学院附属医院 [8]江西医学院附属第二医院 [9]广西医科大学附属第一医院 [10]海南省人民医院

出　　处：《中华医学杂志》2003年第12期1053-1057,共5页National Medical Journal of China

摘　　要：目的　反映 30年来我国原发性肝癌临床诊疗的进展。方法　收集 1996～ 1998年全国10个省市的 32 5 0例原发性肝癌临床资料进行分析 ,并与 30年前的 32 5 4例作对比。结果　平均年龄 (4 9± 12 )岁 ,男女性别之比为 2 3∶1。HBsAg阳性占 81 0 % ,抗HCV阳性占 13 2 %。甲胎蛋白正常占2 5 0 % ,升高者占 75 % ,>4 0 0 μg/L者占 4 4 6 %。实时超声、CT、MRI、肝动脉造影检查的阳性率分别为 97 6 %、98 7%、94 8%和 95 5 %。肝细胞癌占 91 8%。病期 :早、中、晚三期分别占 2 9 9%、5 1 5 %和 18 6 %。手术切除的比例占 4 6 3%。全组患者的 1、3、5年生存率分别为 6 6 1%、39 7%和 32 5 %。早期患者的 1、3、5年生存率分别为 93 5 %、70 1%和 5 9 1%。中期患者的 1、3、5年生存率分别为6 5 3%、30 5 %和 2 3 5 %。晚期病人的半年、1年生存率为 5 2 5 %、14 7%。结论　与 30年前的资料相比 ,我国原发性肝癌“临床相”有显著的变化 ,可以归结为 :由于诊断水平的提高 ,一大批早期肝癌被确诊 ,而晚期肝癌明显减少。手术切除比例增加 ,非手术疗法进步 ,使肝癌患者生存期获得了显著的延长 ,明显地改善了肝癌的临床表现和预后。Objective To study the changes of the clinical aspects of primary liver cancer (PLC) during the past 30 years. Methods The clinical data of 3 250 patients with PLC, from 10 regions of China were collected, analyzed, and compared with the clinical data of 3254 PLC cases 30 years before. Results The 3 250 patients were aged 1～80, with an average age of 49.1 years, younger than those 30 years before (43.7 years). The male to female ratio was 2.3∶1, lower than that 30 years before (7.7∶1). 73.5% of them sought medical advice within 3 months after the onset in comparison of 63.8% 30 years before. Compared with those 30 years before the symptoms and signs were alleviated in general. The HBsAg positive rate was 81.0%, the HCV-Ag positive rate was 13.2%, and the alpha-fetoprotein positive rate was 75%. 1912 cases underwent pathological examination of which 91.8% were diagnosed as with hepatocellular carcinoma. The overall resection rate was 46,3%. Those of early, median, and late stages accounted for 29.9%, 51.5%, and 18.6% respectively in comparison with the rates of 0.4%, 47.0%, and 52.6% 30 years before. The one-year survival rate, three-year survival rate, and five-year survival rate were 66.1%, 39.7%, and 32.5% respectively for the whole group, 93.5%, 70.1%, and 59.1% for the early stage patients, and 65.3%, 30.5%, and 23.5% respectively for the median stage patients. The half-year survival rate and one-year survival rate of the late stage patients were 52.5% and 14.7% respectively. Compared with the data 30 years before a lower percentages of the patients died of hepatic coma, hemorrhage of upper digestive tract and hemorrhage due to rupture of tumor, and a higher percentage of then died of asthenia universalis and other causes. Conclusion In comparison with the situation 30 years ago, PLC can be diagnosed earlier. More patients undergo resection. The prognosis of PLC has been improved greatly.

关 键 词：原发性肝癌 甲胎蛋白 预后 影像学检查 临床医学 肿瘤转移 

分 类 号：R735.7[医药卫生—肿瘤]