| Objective: Primary liver carcinoma(PLC)is one of the most common malignant tumors in clinic,with poor prognosis and various affecting factors.Histology of hepatoma is mainly divided into three types: hepatocellular carcinoma(HCC),intraheptic cholangiocarcinoma(ICC)and combined hepatocellular carcinoma(CHC).The incidence of ICC appears to have increased in the past ten years,but it is not clear whether the pathological distribution of the PLC has changed significantly.Previous studies have explored the factors affecting the prognosis of liver cancer of different pathological types,but the conclusions are different.Therefore,this paper aims to further study the pathologic distribution of PLC and the factors influencing the prognosis.Methods: A retrospective analysis was carried out on PLC patients who accepted tumor resection in The First Affiliated Hospital of Xi'an Jiaotong University between January 1,2002 and January 31,2012.A total of 505 cases were in accordance with the inclusion criteria.The relevant data of the enrolled patients were collected and 22 potential clinical and biochemical indexes that may affect the prognosis of the liver cancer patients were selected for analysis,including gender,age,previous history of hypertension,diabetes,drinking,smoking severity,familial aggregation,etiology,serum AFP level,liver biochemistry indexes(ALT,AST),Child-Pugh grade,TNM stage,location,number and size of tumor,pathological type,type of etiology,portal tumor emboli,capsular infringement,intrahepatic metastasis and lymph node metastasis.Patients were followed up for survival.SPSS 19.0 was used for statistical analysis.Kaplan-Meier method was used for univariate survival analysis,Log-rank method was used to compare the survival rate among groups,and Cox proportional survival risk model was adopted for multiple-factor analysis.P<0.05 was set as a statistical difference.Results:1.General information and pathological distribution: Among 505 cases,399 cases were males(79.01%)and 106 cases were females(20.99%).four hundred and forty-four cases were HCC(87.9%),47 cases were ICC(9.31%),and 14 cases were CHC(2.77%).2.Survival of PLC patients with different pathological types: The median survival timewas 25 months in HCC patients,7.0 months in ICC patients,and 15.0 months in CHC patients.The 1,3 and 5 year survival rates were 87.6%,46.8% and 38.9%,respectively,in HCC patients,46.8%,38.2% and 36.1%,respectively,in ICC patients,and 64.2%,0% and0%,respectively,in CHC patients,respectively.Survival among PLC patients with different pathological types were compared,and the result was significant(P=0.001).3.The independent factors affecting the prognosis of PLC patients: Smoking severity(P=0.000),drinking(P=0.031),AFP(P=0.000),number of tumors(P=0.002),tumor size(P=0.000),lymph node metastasis(P=0.000),TNM stage(P=0.000),the etiology(P=0.001)and pathologic types(P=0.001)were independent factors for the prognosis of PLC patients.4.The independent impact factors for the prognosis of HCC patients: Smoking severity(P=0.000),AFP(P=0.000),number of tumors(P=0.004),tumor size(P=0.000),TNM stage(P=0.000),and the etiology(P=0.000)were independent factors for the prognosis of HCC patients.5.Independent prognostic factors for the prognosis of ICC and CHC patients: Child classification(P=0.000),capsular invasion(P=0.016),lymph node metastasis(P=0.001),and etiology(P=0.005)were independent prognostic factors for ICC and CHC patients.6.Survival of PLC patients with different causes: Among the 505 cases,373 cases were with liver cancer related to the hepatitis B virus(HBV),48 cases with liver cancer related to hepatitis C virus(HCV),80 cases with non-virus liver cancer,and 4 cases with liver cancer associated with HBV and HCV infection.Because the number of cases of co-infection of HBV and HCV were too small,they were not included the analysis.The medium survival was 24.0 months in patients with HBV-related hepatocellular carcinoma,14.5 months in patients with HCV-related hepatocellular carcinoma,and 23.5 months in patients with non-virus related hepatocellular carcinoma.The 1,3 and 5 year survivals were 86%,47.7%and 40.2% in patients with HBV-related hepatocellular carcinoma,62.5%,35.4% and 31.3%in patients with HCV-related hepatocellular carcinoma,and 83.8%,38.8% and 31.3% in patients with non-virus related hepatocellular carcinoma,respectively.Conclusions:1.HCC remains the main pathological type of PLC,accounting for 87.9%,andfollowed by ICC and CHC,accounting for 9.31% and 2.77%,respectively.2.HCC patients had significantly better survival than ICC and CHC patients.Smoking severity,drinking,AFP,the number of tumor,tumor size,lymph node metastasis,TNM staging,pathologic type and pathological type were independent factors influencing the prognosis of PLC patients.3.Smoking severity,AFP,number of tumors,tumor size,TNM staging and etiology were independent prognostic factors of HCC patients.4.Child classification,capsular invasion,lymph node metastasis,and etiological type were independent factors affecting the prognosis of ICC and CHC patients.5.Etiological analysis found that the survival time of HBV-related liver cancer patients(24 months)was longer than that of non-virus-related liver cancer(23.5 months)and HCV related liver cancer(14.5 months). |
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