| Background: Primary liver cancer occurs when a tumor develops from hepatocytes orbiliary epithelia cells within the liver. It poses one of the major threat to human health, whichaccounts for600thousand deaths worldwide. In our country, PLC is becoming the secondleading cause of cancer death. Besides, the incidence of primary liver cancer in the elderlycontinues to rise as the population ages. As a special population, senile patients with primaryliver cancer, when compared to non-senile patients, have their own features in clinical andpathological characteristics.Until now, there are several treatment options for liver cancer in China and abroad,including surgical resection, liver transplantation, transarterial chemoembolization (TACE),radiofrequency ablation, radiotherapy, chemotherapy, biological therapy, combined therapy,etc. Surgery is the first strategy for the majority of patients with liver cancer, providing a5-year survival rate up to70%in certain cases who undergo an operation following strictindication. Resection is still feasible for some liver cancer patients with large tumor burdenafter a remarkable reduction of the tumor mass under comprehensive therapy. Forunresectable primary hepatic carcinoma, individualized treatment, such as combined therapyor sequential therapy according to patients’ characteristics, can improve therapeutic efficacy.In clinic practice, surgery is only suitable for a relative low proportion of the senilepatients with primary liver cancer for the reason that the majority of these patients have highoperation risk, including compensation defects in functions of multiple organs, and underlyingdiseases such as hypertension, heart disease, diabetes mellitus, and cerebrovascular disease.Therefore, it is vastly important to do the research for improving diagnosis and treatmentlevel of the senile patients with primary liver cancer. In the present study, we retrospectively analyzed the clinical data of150senile patients(over sixty-year old) with primary liver cancer who were admitted to Chongqing SouthwestHospital between September2004and September2007. A cohort of150non-senile patients(over twenty-year old and less than sixty-year old) with primary liver cancer in SouthwestHospital in the same period were used as the control group. We aimed to figure out theprognostic factors in senile patients with primary liver cancer by analyzingclinicopathological characteristics and therapeutic strategies, which will provide someinformation for diagnosis and treatment of senile patients with primary liver cancer.Objective: To analyze the clinicopathological characteristics of senile patients withprimary liver cancer and explore the effect of varying treatment strategies to prognosis ofthese patients.Methods: One hundred and fifty senile patients with primary liver cancer who wereadmitted to Southwest Hospital between September2004and September2007were set asobservation group, which were then divided into surgical operation group, interventionaloperation group and conservative treatment group. A homochronous cohort of150non-senilepatients with primary liver cancer was set as control group, which was also divided into threesubgroup as that in observation group. Clinical characteristics, pathological grades,biochemical criteria as well as survival rates of1,2,3and5-year were statistically analyzedbetween observation group and control group. And the prognostic influence ofclinicopathological characteristics and treatment strategies were summarized. Measurementdata were expressed as the mean±SD. Numeration data were expressed as n. Statisticalanalysis was performed using the SPSS software package (SPSS version17.0). Comparisonsof continuous variables were made using the Student t test. Comparisons of categoricalvariables were made using Pearson’s chi-square test. Values of P <0.05were considered toindicate statistical significance.Results: Part I Clinical and Pathological Characteristics of Senile Patients with PrimaryLiver Cancer1. The clinical characteristics of senile patients with primary liver cancer with poorappetite, history of hepatitis B, liver cirrhosis, diabetes mellitus, heart disease, as the mainclinical features, there were104,106,69,106and42cases, respectively. Young andmiddle-aged patients with primary liver cancer with liver area ache, and upper abdomen bag piece as the main clinical features, with117cases and105cases respectively.2. Common biochemical indicators, the observation group of ALT, TCHO, TBIL,propagated were42.3+/-11.7U/L,6.2+/-1.5tendency for L,38.5+12.1U mol/L,12.1+/-6.8g/L, the control of ALT, TCHO, TBIL, propagated were63.5+/-17.3U/L,4.1+/-1.3tendency for L,37.5+10.0U mol/L,10.0+3.9g/L. Two groups of patients in addition tothe TBIL, ALT, TCHO and propagated statistically significant, p <0.05.3、Pathology classification, observation group a total of55patients had definitepathological diagnosis, including Ⅰ level26cases, Ⅱ21cases, Ⅲ level8cases, patientswith advanced differentiation accounts for the number of cases is quite high. In the controlgroup, a total of48patients had definite pathological diagnosis, Ⅰ, Ⅱ level and Ⅲ cases in5cases,9cases and34cases respectively, showed a trend of the high proportion of patientswith low differentiation.Part II Prognosis analysis to common treatment1. There are37cases had surgery in150cases of elderly patients with primary livercancer,,1,2,3,5year survival rates were81%,64.9%,56.8%,64.9%; Accept theinterventional treatment in68patients,70.6%,51.5%,36.8%,51.5%; Conservative treatmentof45cases,1,2,3,5year survival rates were13.3%,6.7%,2.2%,0%. In150cases of youngand middle-aged patients with primary liver cancer, surgery treatment of43cases,79.1%,60.5%,53.5%,60.5%; Accept the interventional treatment in72patients,1,2,3,5yearsurvival rates were66.7%,52.7%,38.9%,12.5%; Conservative treatment of35cases,1,2,3,5years survival rate were14.3%,5.7%,2.9%and0%respectively.2. According to the statistical analysis, the results showed that the same treatment for theelderly and the young and middle-aged patients with primary liver cancer survival rates haveno obvious influence, P values>0.05; For elderly patients with primary liver cancer, surgerytreatment group1,2,3,5year survival rate and interventional treatment group has thedifference, P values <0.05; And surgery, interventional treatment of1,2,3,5year survivalrates were significantly better than the conservative treatment, P values <0.05. In old age inthe three main methods on the therapy of primary liver cancer, the effect and prognosis ofsurgical treatment is best, followed by interventional therapy, and the effect of conservativetreatment and prognosis is the worst. Conclusion:1. Compared to the young and middle-aged patients with primary carcinoma of the liver,primary carcinoma of the liver and clinical features of elderly patients showed differentbiochemical characteristics and group classification results.2. Different treatment modality for elderly prognosis of HCC is different, surgery is oneof the important methods to improve the old patients with primary liver cancer survival rates,even if for some reason can not surgery, interventional treatment can obtain a relatively idealtreatment effect. |
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