| Objective: Primary hepatic carcinoma(PHC) was one of the most commom malignancy in china and even the world, cancer mortality is home to the second position and it was on the increasing trend. As in all its higher malignant cancer, more difficult treatment, faster development and shorter survival time. PHC had been recognized as one of the most serious malignancy hazardous to human life and health. Hepatitis B virus and hepatitis C virus infection were the important liver cancer risk factors. Several studies had examined the differences among HBV-related PHC (HBV-PHC) and HCV-related PHC (HCV-PHC). However, most investigations focused on surgical patients only. Furthermore, the case numbers were small and the follow-up period was not long enough. Our study compared the clinical features and survival in patients with Hepatitis B virus -related primary hepatic carcinomas(HBV-PHC) and Hepatitis C virus-related primary hepatic carcinomas(HCV-PHC) in order to provide valuable information to instruct therapy.Methods: The data of 312 hepatocellular carcinoma patients treated in the forth hospital of Hebei Medical University from January 2002 to June 2006 were retrospectively analyzed, the clinical information was complete. Those patients were divided into four groups, they were hepatitis B virus-related primary hepatic carcinomas, hepatitis B virus-related primary hepatic carcinomas, coinfection of HBV and HCV primary hepatic carcinomas and non-hepatitis B non-hepatitis C-related primary hepatic carcinomas. The clinical features were compared in our study; and we looked up the cases and followed up survival status of these patients by phone and letter. At the same time, we selected Ki-67, 8-OHdG and CD34 pathological index, use IHC to detect the expression in PHC tissues. To obtain the independent prognostic factor, we selected twelve clinical and pathological indexes to analyse which maybe affected the prognosis of PHC. All statistical analysis was performed by SPSS13.0 software. the measurement data was analyzed by T test. Kaplan-Meier method was used to evaluate survival rates and median survival period. The prognostic factors were analyzed by univariate log-rank analysis and Cox`s regression model of multivariate analysis was done in order to determine clinicopathologic factors which had influenced the PHC patients. p<0.05 was considered statistically significant.Results:1 General documents The data of 312 hepatocellular carcinoma patients treated from January 2002 to June 2006 in the furth hospital of Hebei Medical University were retrospectively analyzed, the clinical information was complete, there were 184 patients with hepatitis B virus-related primary hepatic carcinomas(60.0%), 51 patients with hepatitis B virus-related primary hepatic carcinomas(16.0%), 32 patients with coinfection of HBV and HCV primary hepatic carcinomas(10.3%) and 45 patients with non-hepatitis B non-hepatitis C-related primary hepatic carcinomas(13.5%).2 Clinical features2.1 Age and sex of PHC patients The mean age of HCV-HCC patients was older than those of HBV+HCV-PHC, NBNC-PHC patients,or HBV-PHC patients respectively. The male/female ratio was highest in HBV-PHC, while it was lowest in HCV-PHC.2.2 Biochemical index in PHC patients The serum bilirubin levels were respectively lower in the HCV-HCC, HBV+HCV-PHC patients compared with those in the HBV-PHC or NBNC-PHC patients , but there was no statistically significant difference in the mean serum albumin levels among all four groups. The mean ALT level was lowest in the NBNC-PHC patients. Though the mean ALT level was slightly higher in the HCV-PHC patients, there was no statistically significant difference in the mean ALT level between HBV-PHC and HCV-PHC patients. The mean prolongation of prothrombin time, presence of ascites or encephalopathy were similar among all four groups. The HBV-PHC group had higher AFP levels than other groups. The mean tumour size was largest in the NBNC-PHC group, followed by the HBV-PHC, HBV+HCV-PHC and HCV-PHC groups. There were no statistically significant differences in the tumour numbers between different groups. The tumor of NBNC-PHC patient has the single shot majority, while the tumor of HCV-HCC patient accounts for the proportion by sending to be high.3 Pathological characteristicsIn 131 surgical patients of PHC, 103 cases underwent the immunohistochemical test to detect the expression of Ki-67, CD34, 8-OHdG, in which include 92 HBV-PHC cases and 11 HCV-PHC cases.3.1 The tumor characteristic of PHCThe tumor size of HBV-PHC patients was bigger than the HCV-PHC patients. The tumor of HBV-PHC patient had the single shot majority, while the tumor of HCV-PHC patient accounted for the proportion by sending to be high. The proportion of HBV-PHC patient who had PVTT was higher than the HCV-PHC and the proportion of tumor capsule was lower than the HCV-PHC patient.3.2 The expression of the Ki-67, CD34, 8-OHdG in PHC patient3.2.1 The expression of the Ki-67, CD34, 8-OHdG by immunohistochemicalKi-67 were located in nucleus,positive cells with brown nuclear staining and distributed in intratumor. And were scattered in liver parenchyma. Ki-67-positive cells did not show any morphological change(atypical hyperplasia and degeneration)and neither was there any zonal distribution of these positive cells.8-OHdG were located in nucleus, positive cells with brown nuclear staining and distributed in intratumor. And were scattered in liver parenchyma.The high density coloring area of CD34 were mostly located in tumor peripheral tissue. All cases of PHC expressed CD34 protein with dotty, circular staining pattern.3.2.2 The expression of Ki-67,CD34,8-OHdG in the liver cancer cells.There were no differences between the expression of Ki-67 in HBV-associated PHC and HCV-associated PHC. There were no differences between the expression of 8-OHdG in HBV-associated PHC and HCV-associated PHC. There were no differences between the expression of CD34 in HBV-associated PHC and HCV-associated PHC.4 Follow-up survival rate Among the 312 hepatocellular carcinoma patients,the patients with HCV-PHC had the best overall survival. Our data showed that the median survival time in patients with PHC patients was 36 months and the 1-,2- and 3- year survival rates were 76.5%,57.4% and 46.8% respectively. There were no statistically significant differences in the disease-free survival between different groups in the 131 surgical patients. In the 78 patients who received transarterial chemoembolisation (TACE) or 103 patients who received supportive care, the HCV-PHC patients had the best survival, and the HBV+HCV-PHC patients had the worst survival. Univariate analysis showed that serum AFP, tumor size, tumor number, Hepatic function grade (Child-PughA, B, C), homotype clumping in portal vein, tumor capsule, Ki-67, 8-OHdG, CD34 were significant prognostic factors ( p<0.05),while sex, age, clinical stage(â… ,â…¡,â…¢stages) didn't affect the prognosis (p>0.05). Cox multivariate analysis indicated that only Hepatic function grade ( Child-PughA, B, C), tumor number , homotype clumping in portal vein, 8-OHdG and CD34 were significant prognostic factors ( p<0.05).Conclusions:1 Compared with HBV-PHC patients, the patients with hepatitis C virus-related primary hepatic carcinomas have better overall survival.2 The more the number of liver tumor, the lower the survival rates. PVTT and tumor capsule are prognostic risk factors influencing the survival rate of primary hepatic carcinomas.3 The expressions of 8-OHdG and CD34 maybe important diagnostic value in primary hepatic carcinomas diagnoses. The high expression of 8-OHdG and CD34 could be used as feasible determinants for bad prognosis of primary hepatic carcinomas. |
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