Analysis Of Prognostic Factors And Clinical Studies Of Antiviral Therapy In Hepatitis B Virus-Associated Primary Hepatic Cancer

Objective(1) To learn the gender, age and cause distribution of primary hepatic cancer(PHC) in the region of Tai'an.(2) To investigate the prognostic factors and effects of antiviral therapy on HBV–associated PHC patients.(3) To observe the effect of antiviral therapy on the clinical indicators of HBV–associated PHC patients, and evaluate the role of antiviral therapy objectively.Methods(1) The clinical datas of 252 patients who were first diagnosed as PHC in the Department of Hepatology of the 88th Hospital of PLA from July 2009 to November 2010 were collected, and then analysis the gender, age and cause distribution by SPSS 13.0.(2) According to inclusion criteria and exclusion criteria, select 179 eligible cases and 23 prognostic factors affecting HBV–associated PHC prognosis(gender, age, AFP, ALB, TBIL, ALT, AST, GGT, PT, HBV DNA positive, ascites, tumor numbers, tumor location, portal vein tumor thrombus, extrahepatic metastasis, clinical stage, liver pain, cirrhosis history, treatment methods, times of treatment, Child-Pugh classification, ECOG classification, antiviral therapy).Life table was used to calculate the survival rate, Kaplan-Meier of univariate analysis and Cox proportional hazard model of multivariate analysis were done in order to screen on the independent prognostic factors of PHC.(3) 82 HBV–associated PHC paitents were divided into two groups, study group(n=41)received antiviral therapy. Liver function, Child-pugh score, HBV DNA negative rate after therapy of the two groups were compared.Results(1) 252 cases of PHC patients, male to female ratio was 5.3:1; less than 45 years of age accounted for 17.86%, 45 to 60 years old accounted for 47.22%, 34.92% accounted for more than 60 years old; 88.1% of patients with hepatitis B surface antigen positive.(2) Univariate analysis showed that nineteen prognostic factors of AFP, ALB, TBIL, ALT, AST, GGT, PT, ascites, tumor numbers, tumor location, portal vein tumor thrombus, extrahepatic metastasis, clinical stage, liver pain, treatment methods, times of treatment, Child-Pugh classification, ECOG classification, antiviral therapy in the prognosis of HBV–associated PHC were significant (P<0.05), while the last four prognostic factors of gender, age, HBV DNA positive, liver cirrhosis history in the prognosis were non-significant (P>0.05).(3) Multivariate analysis showed that AST, GGT, Child-Pugh classification, clinical stage, portal vein tumor thrombus, times of treatment and antiviral therapy in the prognosis were significant (P<0.05), while AFP, ALT, tumor numbers, tumor location, extrahepatic metastasis, liver pain, treatment methods, ECOG classification were non-significant (P>0.05).(4) PI=0.782X7(AST, 80U/L=0, >80U/L=1)+0.28X8(GGT,≤100U/L =1, 100～200 U/L=2,≥200U/L=3)+0.412X15(portal vein tumor thrombus, yes=1, no=0)+0.529X17 (clinical stage,Ⅰ=1,Ⅱ=2,Ⅲ=3)-0.536X22(times of treatment, 0 times=0, 1～2 times=1,≥3 times=2)+0.372X23(Child-Pugh classification, A=1,B=2, C=3)-0.636X25(antiviral therapy, yes=1, no=0).(5) ALT and HBV DNA negative rate of the antiviral treatment group were better than the control group after 1, 3 and 6 months of therapy (P<0.05). Child-Pugh classification, AST and GGT were lower in the treatment group than the control group after 3 and 6 months(P<0.05).Conclusion(1) Incidence of PHC in male in this region is significantly more than in female, which were mostly middle-aged patients, but elderly patients still accounts for a large proportion, and hepatitis B virus infection is still the main cause for PHC.(2) AST, GGT, Child-Pugh classification, clinical stage, portal vein tumor thrombus, times of treatment and antiviral therapy are the independent prognostic factors of HBV–associated PHC, and AST, GGT, Child-Pugh classification, clinical stage, portal vein tumor thrombus are risk factors, while times of treatment and antiviral therapy are protective factors.(3) Prognostic index (PI) can be applied to predict the prognosis of patients:PI value is bigger, the higher risk of death, the worse the prognosis. (4) Antiviral therapy of nucleoside analogues can quickly inhibit viral replication, reduce inflammation of the liver, stable liver function, improve patient quality of life and improve prognosis.