Analysis Of The Clinical Features And Prognostic Factors Of 626 Patients With Primary Hepatic Carcinoma

ObjectiveBy retrospectively analyzing the clinical datum of a large number of patients with primary hepatic carcinoma hospitalized in Qianfoshan Hospital,Shandong province,we may systematically summarize the clinical features of patients with primary hepatic carcinoma and screen out the factors related to the survival of primary hepatic carcinoma to enventually formulate out more effective treatment models of primary hepatic carcinoma.Thus,the research can be one of those provide evidence-based medical theory for diagnosis and prognosis of primary hepatic carcinoma.Materials and MethodsThe 626 patients with primary hepatic carcinoma hospitalized in Qianfoshan Hospital,Shandong province were collected from January 2012 to December 2016.We collect those potential factors to establish a primary hepatic carcinoma database,including gender,age,ECOG score,number of hospitalizations,treatment methods,past history,personal history,family history,initial clinical manifestations,the number of tumors,tumor size,portal vein tumor thrombus,extrahepatic metastasis,TNM newly diagnosed tumor staging,pathological type,liver biochemical indicators,coagulation index,antiviral therapy,diagnosis methods.The SPSS 20.0 statistical software was used to analyze the data.Survival rate was calculated using life table method.Kaplan-Meier method was used to evaluate survival rate.Cox proportional hazard model was used to analyze univariate and multivariate analysis.P<0.05 was considered statistically significant.ResultsFollow-up results:The follow-up deadline is December 2017.There were 349 deaths,systemic failure,hepatic encephalopathy,upper gastrointestinal bleeding and tumor rupture are the main causes of death.The overall survival rates of 626 patients with PHC at 1 year,2 years,3 years and 5 years were 72.20%.46.33%.38.50%and 11.50%,respectively.The mean survival time was 23 ± 4 months and the median survival time was 28 months.The survival rates of 1,2,3,5y were 84.81%,66.77%,47.15%and 19.94%in the group of comprehensive treatment;In the group of liver transplantation the survival rate of 1,2,3,5y were 87.50%,68.75%,56.25%,25.00%;84.27%,62.44%,45.31%,23.00%in the group of Liver surgical resection;The survival rates of 1,2,3,5y were 76.06%,56.57%,41.31%and 17.37%in the TACE group;The survival rates of 1,2,3,5y were 79.08.2%,60.20%,45.41%and 16.33%in the local ablation group;The survival rates of 1,2,3,5y were 60.50%,38.00%,31.00%,8.50%in the group of radiotherapy;The survival rates of 1,2,3,5y were 70.87%,50.49.00%,32.11%,10.68%in the chemotherapy group;The survival rates of 1,2,3,5y were 60.00%,40.00%,20.00%,15.00%in the group of targeted therapy;The survival rates of 1,2,3,5y were 14.40%,5.90%,2.50%and 0.00%in the group of simply support treatment.2.Our hospital primary hepatic carcinoma survival analysis(1)Overall survival analysis of 626 patients with PHC:The COX proportional hazards models showed that age,number of hospitalizations,Portal vein tumor thrombus,TNM newly diagnosed stage,initial clinical presentation,Child-Pugh classification,and treatment method were independent prognostic factors.(2)316 patients with hepatic carcinoma in the comprehensive treatment group:COX regression analysis showed that ECOG score,TNM newly diagnosed stage,extrahepatic metastasis and portal vein tumor thrombus,the initial clinical manifestations、Child-Pugh classification were independent prognostic factors.(3)16 patients with hepatic carcinoma in the group of liver transplantation:COX regression analysis showed that only Child-Pugh classification was an independent prognostic factor.(4)144 patients with hepatic carcinoma in the group of surgical resection:COX regression model showed that the number of hospitalizations,TNM newly diagnosed staging,portal vein tumor thrombus,Child-Pugh classification is an independent prognostic factor.(5)426 patients with hepatic carcinoma in the group of TACE:COX regression model showed extrahepatic metastasis,portal vein tumor thrombus,antiviral therapy,initial clinical manifestations and Child-Pugh classification were independent prognostic factors.(6)196 patients with hepatic carcinoma in the group of local ablation:The COX regression model showed that hepatitis history,TNM newly diagnosed stage,the number of tumors,anti-virus treatment,and initial clinical manifestations were independent prognostic factors.(7)40 patients with hepatic carcinoma in the group of radiation therapy:COX regression model showed ECOG score,TNM newly diagnosed stage is an independent prognostic factor.(8)103 patients with hepatic carcinoma in the group of chemotherapy:COX regression model showed that the number of hospitalizations,ECOG score,tumor size is an independent prognostic factor.(9)20 patients with hepatic carcinoma in the group of targeted treatment:Multivariate analysis showed no statistically significant.Conclusion1.The clinical features of patients with primary hepatic carcinoma in our hospital:PHC was mostly associated with older men,loving tobacco and alcohol,combined with hepatitis or cirrhosis,poor liver function reserve,mostly in the late treatment.And It is similar to our country overall characteristics.2.The different treatment methods of liver cancer make patients have different prognosis.Rational choice of comprehensive treatment model can significantly improve the survival rate of liver cancer patients.3.The prognosis of liver cancer patients has a high degree of heterogeneity,which is related to the factors that coexist and affect each other between the tumor and the body.The survival prognostic factors of common treatment methods are also diverse,including tumor stage,portal vein tumor thrombosis,liver function Child-Pugh grading and initial clinical manifestations.Scientifically and rationally selecting indications,effective improvement of liver function and general status can play a positive role in the prognosis of liver cancer.