| ObjectiveTo evaluate the risk factors affecting the survival rate and survival time for primary liver cancer (PLC). And to compare3different therapeutic programs of the medium-stage or late-stage PLC, try to find the best choice to obtain a longer survival rate.Methods99cases older than age60of medium or late stage of PLC treated in the last6years by Oncology Department of the First Affiliated Hospital of Guangzhou University of Chinese Medicine were retrospectively studied. The cases were divided into3groups by different therapeutic programs. The3groups are as follows:simple treatment of Chinese Medicine, trans-catheter arterial chemoembolization (TACE) AND/OR radio frequency ablation (RFA) adding treatment of Chinese Medicine, systemic chemotherapy OR molecular targeted drugs adding treatment of Chinese Medicine. The cumulative survival rate of each therapeutic program was analyzed by the Kaplan-Meier statistical method. Summarized all the therapies in two large groups as simple treatment of Chinese Medicine and combined treatment of traditional Chinese Medicine and western medicine, then the cases were divided into3groups by different stages of the China Staging (CS) system. Also the cumulative survival rate of each stage with either group was analyzed by the Kaplan-Meier statistical method.22prognosis factors were selected, and analyzed by the Cox regression method. The dangerous factors and protective factors were screened out, which might offer references for clinical treatment of PLC in the future.ResultsThe ages were mainly in group60to69of these99cases and the majority of their genders were male. Two out of three had history of hepatitis infection and half of them got liver cirrhosis and/or complications. The most common TCM syndrome was liver depression and spleen deficiency and the next was deficiency syndrome of both liver and kidney yin. Ⅱ B and Ⅲ A of CS staging were mainly made up of liver depression and spleen deficiency syndrome however stage ⅢB was mainly made up of deficiency of both liver and kidney yin syndrome. The amounts of different Child-Pugh grades decreased from A to C. The amounts of different CS staging were stage Ⅲ A for most and stage Ⅲ B for least. Hepatocellular carcinoma (HCC) stood for75.3%when Intrahepatic cholangiocarcinoma (ICC) stood for24.7. More than half of the cases were larger than5cm and located in the whole liver. About half had portal vein tumor thrombosis and they often happened in the main vein. The amounts of3therapeutic programs decreased from TACE AND/OR RFA adding treatment of Chinese Medicine to systemic chemotherapy OR molecular targeted drugs adding treatment of Chinese Medicine. While combined treatments of Chinese Medicine and western medicine were chosen more than simple treatment of Chinese Medicine in stage Ⅱ B and Ⅲ A, opposite choice happened in stage ⅢB.Among the3groups of therapeutic programs, TACE AND/OR RFA adding treatment of Chinese Medicine showed the best effect but showed no significant difference with systemic chemotherapy OR molecular targeted drugs adding treatment of Chinese Medicine (P>0.05). The simple treatment of Chinese Medicine showed implied significant differences with the other two groups (P<0.01). Their median survival times were9,8and4months. The median survival times of3stages with combined treatment of traditional Chinese Medicine and western medicine were12,8and3months when those with simple treatment of Chinese Medicine were10,5and2months. The survival time with combined treatment of traditional Chinese Medicine and western medicine showed much longer than that with simple treatment of Chinese Medicine in stage ⅢA (P<0.01). Statistics could not be done because the amounts of simple treatment of Chinese Medicine in stage Ⅱ B and combined treatment of traditional Chinese Medicine and western medicine in stage IIIB were not enough. Carbohydrate antigen19-9(CA19-9)(P=0.001), alkaline phosphatase (ALP)(P=0.003), types of pathology (P=0.010), CS staging (P=0.014), Child-Pugh grading (P=0.007), TACE (P=0.001), and portal vein tumor thrombus (P=0.047) were related to the survival rate of PLC. The rest factors showed no significant effect of the survival time, and then analyzed these significant factors by Cox regression. The survival rate was lower when the value of ALP got higher, or had existence of portal vein tumor thrombus. The application of TACE was the most effective and protective factor (P=0.001).Conclusions1. Ages from60to69were high incidence of advanced PLC in elderly patients, and viral Hepatitis combined cirrhosis of liver might be the main cause of the disease.2. The most common TCM syndrome of advanced PLC in elderly patients was liver depression and spleen deficiency. Deficiency syndrome of both liver and kidney yin was often seen in late-stage patients.3. The main pathological type of advanced PLC in elderly patients was HCC; however ICC showed out24.7%. The volumes of tumors were large, the locations of tumors were extensive and many were with portal vein tumor thrombus.4. Both TACE AND/OR RFA adding treatment of Chinese Medicine and systemic chemotherapy OR molecular targeted drugs adding treatment of Chinese Medicine show longer survival time than simple treatment of Chinese Medicine.5. Compared with other patients, those chose TACE AND/OR RFA adding treatment of Chinese Medicine got higher survival rate (P<0.05).6. Compared with other patients, those chose systemic chemotherapy OR molecular targeted drugs adding treatment of Chinese Medicine might be good for increasing survival rate.7. To staging Ⅱ B and Ⅲ A of PLC in elderly patients, combined treatment of traditional Chinese Medicine and western medicine might increase the cumulative survival rate. Especially, TACE AND/OR RFA adding treatment of Chinese Medicine might be the best way to get a longer survival time.8. Factors such as age, gender, History of hepatitis, complications; abnormal of AFP, AST, ALT, ALP, GGT; tumor size, quantities, locations, et al had no significant meaning to the prognosis of advanced PLC in elderly patients.9. Therapies of TACE AND/OR RFA were protective factors of advanced PLC in elderly patients, might prolong the survival time.10. Portal vein tumor thrombus, the abnormal of CA199, the TCM syndrome deficiency syndrome of both liver and kidney yin, Child-Pugh grading, CS staging were independent risk factors of advanced PLC in elderly patients, which might decrease cumulative survival rates. |
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