-
摘要: [目的]分析168例晚期肝癌伴不同部位转移的生存情况。[方法]回顾性分析2010年1月~2013年12月期间我院收治的168例晚期肝癌患者,所有患者均伴不同部位转移,根据患者单器官转移、多器官转移、转移部位不同,分析1年生存率和平均生存时间的组间差异,采用Cox模型进行多因素预后分析,以了解不同部位转移灶对晚期肝癌患者生存情况的影响。[结果]168例患者平均生存时间为(13.1±1.28)个月。单因素分析结果显示年龄≥60岁、多器官转移、有不良嗜好、甲胎蛋白(AFP)≥400 ng/ml、肿瘤直径≥5 cm、病理分型为混合型肝癌的患者平均生存时间分别为(12.5±0.9、9.4±0.9、11.7±1.3、11.7±1.4、12.6±1.1和11.5±1.3)个月,均短于＜60岁、单器官转移、无不良嗜好、AFP＜400 ng/ml、肿瘤直径<5 cm、病理分型为肝细胞癌和胆管细胞癌的患者(13.5±1.3、14.0±1.7、13.8±1.5、13.9±1.8、13.8±1.3、13.1±1.6和13.3±1.7)个月(均P<0.05)。多器官转移1年生存率为31.3%,低于单器官转移患者55.9%(P<0.05)。单器官转移生存分析显示,骨转移患者1年生存率最低,为25.0%,其次为肺转移患者34.8%,肝内转移患者1年生存率最高,为69.6%(P<0.05);骨转移患者平均生存时间最短,为(7.8±1.5)个月,其次为肺转移患者(8.6±1.1)月,肝内转移患者1年生存率最高,为(16.5±2.1)个月(P<0.05)。多器官转移生存分析显示伴肺转移1年生存率为21.1%,低于未无肺转移46.2%,伴骨转移1年生存率为16.7%,低于无骨转移1年生存率40.0%;伴肺转移平均生存时间为(8.1±1.1)个月,短于无肺转移(11.1±1.9)个月(P<0.05),伴骨转移平均生存时间为(7.2±1.4)个月,短于无骨转移(10.7±1.5)个月(P<0.05)。多因素统计分析显示伴肺转移、伴骨转移和AFP水平影响晚期肝癌患者预后。[结论]对晚期肝癌伴不同部位转移患者,单器官转移中肝内转移的预后最好,骨转移和肺转移预后最差,多器官转移中伴骨转移和肺转移预后为最差。Abstract: [Objective]To analyse the survival analysis of 168 patients with advanced liver cancer.Methods168 patients with advanced liver cancer from January 2010 to December 2013 were analyzed.1 year survival rate and mean survival time among the groups were analyzed according to the single organ metastasis or multiple organ metastasis and different metastatic sites.Multivariate prognostic analysis was performed using the Cox model to analyze the prognostic factors in patients with advanced liver cancer. [Results]The average survival time of 168 patients was(13.1±1.28)months.Univariate analysis revealed that mean survival time of patients with over 60 years,multiple organ metastasis,bad habits,alpha fetoprotein(AFP)≥400 ng/ml,tumor diameter≥5 cm and mixed hepatocellular carcinoma were(12.5±0.9,9.4±0.9,11.7±1.3,11.7±1.4,12.6±1.1 and 11.5±1.3)months,were shorter than that of the other group(13.5±1.3,14.0±1.7,13.8±1.5,13.9±1.8,13.8±1.3,13.1±1.6 and 13.3±1.7)months(allP＜0.05).1 year survival rate of patients with multiple organ metastases was 31.3%,which was lower than single organ metastasis 55.9%(P＜0.05).Single organ metastasis survival analysis showed 1 year survival rate of patients with bone metastases was 25.0%,lower than lung metastasis 34.8% and patients with intrahepatic metastasis was the highest,which was about 69.6%(P＜0.05).Mean survival time of patients with bone metastasis was(7.8±1.5)months,which was shorter than lung metastasis(8.6±1.1)months.The 1 year survival rate of patients with intrahepatic metastasis was the highest,which was(16.5±2.1)months(P＜0.05).Multiple organ survival analysis 1 year survival rate of pulmonary metastasis was 21.1%,which was lower than that of patients without pulmonary metastasis 46.2%,bone metastasis was 16.7%,which was lower than that of patients without bone metastasis 40.0%;Mean survival time of patients with lung metastasis was(8.1±1.1)months,which was shorter than that of patients without pulmonary metastasis(11.1±1.9)months(P＜0.05),bone metastasis was(7.2±1.4)months,which was shorter than that of patients without bone metastasis(10.7±1.5)months(P＜0.05).Multivariate statistical analysis showed that lung metastasis,bone metastasis and AFP level influenced prognosis of advanced liver cancer. [Conclusion]For patients with advanced liver cancer,the prognosis of intrahepatic metastasis is the best,bone metastasis and lung metastasis were the worst.The prognosis of multiple organ metastases with bone metastasis and lung metastasis was the worst.
-
Key words:
- advanced liver cancer /
- hepatocellular carcinoma /
- survival time
-
-
[1] 张思维, 郑荣寿, 李霓, 等.中国肝癌发病的趋势分析和预测[J].中华预防医学杂志, 2012, 46 (7):587-592.
[2] 张志伟.我国开展肝癌多学科团队诊疗模式的困难与对策[J].肝胆外科杂志, 2014, 22 (4):243-244.
[3] Michelotti GA, Machado MV, Diehl AM.NAFLD, NASH and liver cance.[J]Nat Rev Gastroenterol Hepatol, 2013, 10 (11):656-657.
[4] 李涛, 智绪亭, 周建炜, 等.小剂量阿司匹林协同干扰素-α抑制肝细胞肝癌生长转移的实验研究[J].中华肝胆外科杂志, 2012, 18 (1):50-53.
[5] Kohles N, Nagel D, Jüngst D, et al.Prognostic relevance of oncological serum biomarkers in liver cancer patients undergoing transarterial chemoembolization therapy.[J]Tumor Biology, 2012, 33 (1):33-40.
[6] 中国抗癌协会肝癌专业委员会.原发性肝癌规范化病理诊断方案的专家共识[J].临床肿瘤学杂志, 2011, 16 (3):271-273.
[7] 刘新疆, 王滨.肝癌转移复发监测:磁共振扩散加权成像与外周血分子生物学技术研究进展[J].磁共振成像, 2012, 3 (6):471-477.
[8] Altekruse SF, Henley SJ, Cucinelli JE, et al.Changing hepatocellular carcinoma incidence and liver cancer mortality rates in the United States.[J]Am J Gastroenterol, 2014, 109 (4):542-543.
[9] 戴朝六, 贾昌俊.具高转移风险肝癌的预测及其多学科综合治疗方式优化选择[J].中国实用外科杂志, 2016, 36 (6):630-636.
[10] Yamashita T.Liver cancer:progress in diagnosis and treatments.Topics:VI.Progress in treatments of liver cancer;5.Chemotherapy.[J]Nihon Naika Gakkai Zasshi, 2014, 103 (1):102-103.
[11] 徐国斌, 易广新, 熊斌, 等.原发性肝癌术后早期肝内复发转移36例的介入治疗[J].介入放射学杂志, 2013, 22 (4):325-328.
[12] Trump DL, Fahnestock R, Cloutier CT, et al.Anaerobic liver abscess and intrahepatic metastases.A case report and review of the literature[J].Cancer, 2015, 41 (2):682-686.
[13] Mazzolini G, Ochoa MC, Morales-Kastresana A, et al.The liver, liver metastasis and liver cancer:a special case for immunotherapy with cytokines and immunostimulatory monoclonal antibodies.[J]Immunotherapy, 2012, 4 (11):1081-1085.
[14] 李彦杰, 马毅, 郭志勇, 等.肝癌肝移植术后复发和转移特点及预后因素分析[J].中国实用外科杂志, 2012, 32 (8):655-658.
[15] 吕菁菁, 罗志彬.晚期原发性肝癌的姑息治疗[J].重庆医学, 2016, 45 (15):2142-2144.
[16] Regel I, Eichenmüller M, Joppien S, et al.IGFBP3 impedes aggressive growth of pediatric liver cancer and is epigenetically silenced in vascular invasive and metastatic tumors.[J]Molecular Cancer, 2012, 11 (1):9-12.
[17] 宋泽, 李虹, 齐翰, 等.CT导向下微波消融治疗肝癌肺转移瘤的疗效[J].实用医学杂志, 2015, 31 (1):57-60.
[18] 邱书琚, 曾昭冲, 陈坚, 等.肝细胞肝癌脑转移临床特性和预后分析[J].中华肿瘤防治杂志, 2013, 20 (24):1924-1927.
[19] 吴照宇.中、晚期肝癌介入治疗预后的影响因素分析[J].实用肝脏病杂志, 2015, 18 (4):427-429.
[20] 於雷, 樊嘉, 周俭.肝癌肝移植术后复发转移的分子机制及防治.[J]实用器官移植电子杂志, 2013, 4 (1):50-55.
-
计量
- 文章访问数: 454
- PDF下载数: 142
- 施引文献: 0
下载: