| BackgroudPrimary hepatic carcinoma (PHC) occurs in hepatocytes and in intrahepatic bile ducts cells. It is the fifth commonest cancer worldwide and the second leading cause of cancer-related mortality in China. The disease has been increasing year by year. In China, a vast majority of primary liver cancers are hepatocellular carcinoma (HCC). PHC is a threat to people’s health and life.Now, the treatments of PHC studied worldwide including tumor resection, liver transplantation, TACE, radiotherapy, chemotherapy, molecular target therapy, comprehensive treatment, etc. Hepatic resection is a potentially curative therapy for HCC in early stage. Other treatments, each has its superiorities and weaknesses. Since1963untill now, liver transplantation has become one important treatment for HCC. The liver transplantation can markedly improve survival prognosis if patients were within the milan criteria. TACE has become the first choice for unresectable patients. Repeated treatment and super choose of tumor blood vessels may improve the prognosis. As a local treatment, efficacy of Radiofrequency ablation may closely relate to tumor stage (including tumor size and number, ever distant metastasis). For the late staged patients, Radiotherapy may help improve the local control of TACE. HCC is considered to be a chemotherapy resistant tumor, drugs also used combined with TACE. Each kind of treatments has its limitations, so comprehensive treatment may help to form an individual therapy for HCC. The choice of superposition or sequential treatments is expected to plus the advantage of each treatment to improve the overall survival.China has a high incidence of HCC, specially its southeast coastal region. In China, Chronic hepatitis is highly related to the generation of HCC, there is a large population infected with hepatitis B which will eventually develope into cirosis and next to HCC. HCC is a tumor with high malignancy, rapid progress, and poor prognosis. Although its treatments have been greatly improved, including the advanced molecular target therapy, the overall survival of the disease is still poor.Thus, We need to characterise HCC patients in our hospital to facilitate the clinical monitoring and follow-up of this population in Guangdong province. Meanwhile, we need to screen possible factors related to the total survival for statistical analysis to find out the relationship between clinical measures and prognosis in patients with hepatocellular carcinoma. The findings of such research to explore the factors related to the prognosis after surgry will help doctor to predict effect of the treatment and to choose the optimal therapy.It is therefore necessary to follow up HCC patients and to use their clinical data to establish a database. Then, possible factors related to the total survival can be screened for statistical analysis to find out the relationship between clinical measures and prognosis in patients with hepatocellular carcinoma. The findings of such research to explore the factors related to the prognosis after surgry will supply a theoretical basis for the clinic to predict effect of the treatment and to choose the optimal therapy.Objective We tried to determine the general characteristics of the patients with hepatocellular carcinoma and to explore the prognostic factors for the patients with hepatocellular carcinoma after various treatments. We also tried to determine the independent factors which can help choose an optimal treatment for a specific patient and help predict the prognosis of a specific treatment.MethodsIn this retrospective study, Chi-square test was used to determine differences between groups while COX regression model of risk proportion univariate analysis and multivariate analysis were used to screen prognostic factors. Kaplan-Meier method was used for the survival curve drawing, and Log-rank for P value inspection.ResultsPart I Characteristics of HCC patients’1) Among the308HCC patients, male had a predominant proportion (85.1%) and female a minor proportion (14.9%), with a male-to-female ratio of5.7:1.2) The meadian age of the308HCC patients was53years and the mean age was (51.69+/-12.482) years, indicating more than50%of the patients were between the range of40to60years.3) Of the308HCC patients, HBsAg positive patients accounted for80.5%(n=248) and negative ones19.5%(n=60), with a positive-to-negative ratio of4.1:1.4) Of the308HCC patients, HBeAg positive patients accounted for14.9%(n=46) and negative ones85.1%(n=262), with a positive-to-negative ratio of1:5.7.5) Of the308HCC patients, patients with one mass accounted for69.2%(n=213) and with two or above masses accounted for30.8%(n=95).6) Of the308HCC patients, asymptomatic patients accounted for38.3%(n118) and symptomatic ones accounted for61.7%(n=190).7) Of the308HCC patients, well-differentiated patients accounted for29.5%(n =91) and poor-differentiated ones accounted for70.5%(n=217).8) Of the308HCC patients, patients with right hepatic lobe tumor accounted for55.8%(n=172) and other hepatic lobe tumor accounted for44.2%(n=136).Part II Prognosis of the patients with HCC after different treatments.1)122patients accepted comprehensive treatment. Univariate analysis suggested statistically significant differences in distant metastasis, TBIL value, AST value, pathology classification and antiviral treatment. Multivariate analysis suggested antiviral treatment was an independent prognostic factor (P≤0.05).2)204patients accepted tumor recection therapy:Univariate Analysis suggested statistically significant differences in portal tumor thrombosis, tumor size, AFP value, AST value, ALB value, medical examination, antiviral treatment, TNM staging. Multivariate analysis suggested tumor size, ALB value, TNM staging were independent prognostic factors (p<0.05).3)17patients accepted radiation therapy:Univariate analysis suggested statistically significant differences in only pathologic classification (p<0.05).4)111patients accepted TACE:Univariate Analysis suggested statistically significant differences in distant metastasis, AFP value, TBIL value, AST value, ALB value, physical examination and pathologic classification, antiviral treatment. Multivariate analysis suggested pathologic classification, antiviral treatment were independent prognostic factors (p<0.05).5)28patients accepted RF:Univariate analysis suggested statistically significant differences in distant metastasis, pathology classification. Multivariate analysis suggested distant metastasis was independent prognostic factor (p<0.05).6)16patients accepted chemotherapy:Univariate analysis suggested statistically significant differences in no factor.7)44patients accepted liver transplant:Univariate analysis suggested statistically significant differences in only PT value (p<0.05).8) Patients accepted single treatment:the prognosis of patients accepted tumor resection was much better than who accepted liver transplant (p=0.027).9)244patients accepted surgery, whose prognosis was much better than who did not accept surgery (p=0.000).Part Ⅲ Prognosis of the hepatocellular carcinoma patients with HBV infection after liver surgery.1) Univariate analysis:TNM staging, portal tumor thrombosis, tumor size, AFP value, GGT value, AST value, first sign, antiviral treatment and treatment were statistically significant for prognosis (p<0.05).2) Multivariate analysis:GGT value, AST value, first sign and antiviral treatment were independent prognostic factors (p<0.05).Conclusions1) The features of hepatocellular carcinoma patients were male, age of40to60years, HBsAg positiveness, and repeated pain in the liver area.2) The prognosis for patients with hepatocellular carcinoma after therapy may be related to TNM staging and antiviral treatment of hepatitis. Therefore, antiviral treatment should be recommende at present. Early detection, early diagnosis and early treatment are effective means to improve the curative effect and prognosis for the patients.3) In hepatocellular carcinoma patients with HBV infection after liver surgery, antiviral treatment is an independent factor for improved prognosis. |
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