| Objective:To analyze the clinical data of patients with metastatic hepatic carcinoma,summarize the common sources of primary tumor,and to compare the clinical features,assay index?imaging diagnosis and therapeutic methods of primary hepatocellular carcinoma,for the early diagnosis of metastatic hepatic carcinoma and to find the primary tumor timely and accurately.Providing the reference of the diagnosis and prognosis evaluation of the metastatic hepatic carcinoma.Methods:Retrospectively analysis and collected 221 patients with metastatic hepatic carcinoma who came to the First Affiliated Hospital of Dalian Medical University between September 2014 and October 2016,summarize the common sources of primary tumor and pathological features,comparede with data of 200 patients with primary liver cancer,analysis of two groups of patients with gender,age,history,clinical symptoms and signs,laboratory reports,imagings and other aspects of the differences.Using the receiver operating characteristic curve(receiver operating,characteristic,ROC)to analyze the value of the tumor markers in differential diagnosis of the two group.Results:1.General information:In the metastatic liver cancer group,128 were male,93 were female,male to female ratio =1.37:1,age range 16-87 years old,the average age is 62.13 ± 12.99 years old;In the primary liver cancer group 165 were male,35 were female,male to female ratio =4.71:1,age range 31-84 years old,the average age is 58.87± 9.34 years old.2.The composition of primary tumor in metastatic liver cancer group:both male and female patients were more common in the digestive system,including the largest proportion of colorectal cancer,followed by gastric cancer,third in addition to the primary tumor lesions in the digestive system,the majority of male patients with lung cancer,women with breast cancer,gynecological tumors are more common3.The comparison of gender:in both group,there are more men than women.In the metastatic liver cancer group:the proportion of women was higher than that of primary liver cancer group,the difference was statistically significant(P<0.01)4.The comparison of age:the two groups of patients are mainly aged people.At the age of 60-69 years old the number of metastatic liver cancer group were less than that of primary liver cancer group,and at the age of 70-79,>80 years old is higher than that of primary liver cancer group,the difference was statistically significant(P<0.01)5.The comparison of clinical symptoms,signs,previous history:To compared with the primary hepatic carcinoma group,founding by physical exam,back pain,gastrointestinal bleeding and with abdominal mass in metastatic liver cancer group was higher,the difference was statistically significant(P<0.05).The number of Liver metastasis with drinking history,smoking history,hepatitis B,hepatitis C,cirrhosis patients were lower than those of the primary liver cancer group,the difference was statistically significant(P<0.05).6.The comparison of tumor markers:patients in metastatic hepatic carcinoma group has a lower positive rate in AFP than that of primary liver cancer group,the positive rate in CEA,CA125,CA199 is higher than that of primary hepatic carcinoma group,the difference was statistically significant(P<0.01).AFP?CEA in the area of ROC curve have a better diagnostic performance.7.The comparison of Liver function:Both the two group in Liver function are higher than the normal control group,the ALP,GGT and CHE in MLC group are more higher than that in PLC group,but the ALT,AST,TBIL,DBIL,TBA,AFU were lower than those in MLC group,the difference was statistically significant8.The comparison of imaging characteristics:In the metastatic hepatic carcinoma,the tumor on the two sides of liver lobe?tumor number more than 3,the diameter is less than 5cm are higher than that of primary liver cancer group,and the tumor located in the right lobe of the liver,single tumor,diameter more than 5cm,portal vein tumor thrombus are lower than that of primary hepatocellular carcinoma group,the difference was statistically significant(P<0.01).Metastatic liver cancer patients with CT scan showed round or patchy low density or mixed density,with clear or fuzzy edge.Enhanced scan showed ring enhancement in portal phase,part of a "bull eye sign".CT enhanced in primary liver cancer group is characteristics with lesions grew rapidly and quickly fade.9.Treatment:metastatic liver cancer group often use conservative treatment and chemotherapy,while the primary liver cancer group often use TACE,surgical treatment.Conclusion:1.In the metastatic liver cancer group,the elderly patients are the most.The primary source are most from the digestive system.In addition to the digestive tumor,the male patients are more often in lung cancer,female patients are more often in breast and gynecological tumors.2.The clinical manifestations of metastatic liver cancer are not specific,the degree of liver function damage is lower than that of primary liver cancer.Serum ALP,GGT,CEA,CA125 and CA199 are higher.3.AFP,CEA can be used for differential diagnosis of metastatic liver cancer and primary liver cancer?4.Metastatic liver tumor group often have multiple small nodules,scattered in the liver,no vein tumor thrombus.CT manifest irregular low density lesions,enhanced scan display" bull eye sign" sign.5.In order to prolong the survival time,we should take comprehensive treatment for metastatic liver cancer... |
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