影响乙型肝炎病毒相关原发性肝癌患者生存因素分析

目的分析乙型肝炎病毒相关原发性肝癌（HBV-PLC）患者生存期及其影响因素。方法收集2011年11月至2014年6月我院119例HBV-PLC患者临床资料,应用Kaplan-Meier检验及Cox回归模型,分析影响HBV-PLC患者生存期的因素。结果在119例HBV-PLC患者中,终末期肝癌比例较高,BCLC D期患者41例（34.5%）,Child-Pugh C级79例（66.4%）,伴有基础疾病78例（65.5%）,肿瘤肝内或肝外转移90例（75.6%）,患者中位生存期为287（172,560） d;在HBV-PLC确诊前未抗病毒治疗、抗病毒治疗持续时间<1年、1~3年和>3年患者的中位生存期分别为232（114,390） d、357（179,879） d、530（206,-） d和795（384,912）d（P<0.01）;Cox回归分析提示,民族、Child-Pugh分级、肿瘤转移、年龄、抗病毒治疗、血清HBV DNA水平和肿瘤治疗方式是预测患者生存期的重要因素,相对危险度分别为3.18、1.60、4.86、1.82、1.30、5.88和1.13（P<0.05或P<0.01）。结论影响HBV-PLC患者生存期的因素很多,早期监测、早期干预、规范抗肿瘤治疗将有助于延长HBV-PLC患者的生存期。

Risk factors influencing survival of patients with hepatitis B virus-related primary liver cancer

Objective To clarify the prognostic factors that influence the overall survival（OS）in patients with hepatitis B virus-related primary liver carcer（HBV-PLC）. Methods The clinical data of 119 patients with HBV-PLC from November 2011 to June 2014 in our hospital were retrospectively reviewed,and OS was analyzed by using Kaplan-Meier method,Log-rank test and Cox proportional hazard model. Results There were 41 cases （34.5%） with terminal stage of tumor Barcelona Clinic Liver Cancer（BCLC）stage D ],79（66.4%） with Child-Pugh class C,78（65.5%） with pre-existing diseases,and 90（75.6%） with tumor metastasis among the 119 patients with HBV-PLC;The median overall survival in this series was 287（172,560） days,and the median overall survivals of patients with non-antiviral therapy,with antiviral therapy for less than one year,with antiviral therapy for one to three years,and with antiviral therapy for more than 3 years were 232（114,390） days,357（179,879） days,530 （206-）days,and 795（384,912） days （P<0.01）;The Cox proportional-hazards model demonstrated that nationality relative risk（RR）=3.18,95% CI,1.71~5.91,P=0.000],Child-Pugh class（RR=1.60,95%CI,1.180~2.16,P=0.002）,tumor metastasis（RR=4.86,95%CI,2.72~8.68,P=0.000）,age（RR=1.82,95%CI,1.13~2.95,P=0.014）,antiviral therapy prior to diagnosis of HBV-PLC（RR=1.30,95%CI,1.00~1.69,P=0.048）,serum HBV DNA level （RR=5.88,95%CI,3.22~10.71,P=0.000）and the way targeting tumor therapy （RR=1.13,95%CI,1.01~1.26,P=0.025） were significant predictor of overall survival. Conclusion Many factors might influence the overall survival of patients with HBV-PLC,and the rigorous screening and surveillance in the HBV-infected populations,and effective antiviral therapy for HBV infection are important for prolonging the life of patients with PLC.