| Objective(s):By collecting and sorting out the first confirmed hepatitis B virus(HBV)and hepatitis C virus(HCV)related hepatoma in our hospital,In order to provide some help for clinical diagnosis,treatment and prevention,we analyzed the epidemiological and clinical characteristics of HBV and HCV related HCC patients.Methods:A total of 380 patients with HBV and HCV related HCC were included in this study.The inpatients from the First Affiliated Hospital of Kunming Medical University who met the diagnostic criteria and had complete medical records between January 2010 and December 2019 were selected.The demographic data of the patients included gender,age,occupation,education level,personal history and family history.Clinical data include initial clinical manifestations,laboratory examination data and imaging examination data.Other data include:whether to receive antiviral treatment,duration of antiviral treatment,specific antiviral drugs,child Pugh classification of liver reserve function,BCLC stage of liver cancer,etc.Spss25.0 statistical software was used for data analysis.Results:1.Demographic characteristics:data of 380 cases of HBV and HCV related HCC,including 334 males(87.89%),46 females(12.11%)and 7.26 males to 1 females.Age distribution:the overall age distribution is between 18-85 years old,including 30 cases under 40 years old(7.89%);110 cases between 40-49 years old(28.95%);148 cases between 50-59 years old(38.95%);63 cases between 60-69 years old(16.58%);29 cases over 70 years old(7.63%).The distribution of educational level:107 cases(28.16%)in primary school and below,159 cases(41.84%)in junior high school,57 cases(15.00%)in senior high school,57 cases(15.00%)in junior college and above.Occupation distribution:194 farmers(51.05%),58 company employees(15.26%),9 civil servants(2.37%),54 retirees(14.21%),20 unemployed(5.26%),45 other occupations(11.85%).Personal history:126 cases(33.16%)had long-term drinking history,138 cases(36.32%)had long-term smoking history.Family history:85 cases(22.37%)had family history of liver cancer and cirrhosis.The average age of onset of HCC in 334 male patients was 52.49± 10.78 years,the median age was 52 years.The mean age of HCC was 58.20±7.89 years and the median age was 58 years.The results of data comparison between the two groups showed that there was a statistical difference between men and women in the age of HCC onset(t=-3.459,.P=0.001)(P<0.05).2.Clinical features:among 380 patients with HBV and HCV related HCC,328 were HBV related HCC and 52 were HCV related HCC.Among the 328 patients in the HBV related HCC group,278(84.76%)had a history of liver cirrhosis and 34(10.37%)had a history of diabetes;among the 52 patients in the HCV related HCC group,42(80.77%)had a history of liver cirrhosis and 13(25.00%)had a history of diabetes.There was no significant difference between the two groups in the history of cirrhosis(?2=0.537,P=0.464)(P>0.05),but in the history of diabetes(?2=8.869,P=0.003)(P<0.05).The incidence rate of HCV related HCC patients with diabetes was significantly higher than that of HBV related HCC patients.3.The common first clinical manifestations were:abdominal pain and discomfort in 187 cases(49.21%),abdominal distention in 119 cases(31.32%),asymptomatic in 81 cases(21.32%),asthenia in 72 cases(18.95%),poor in 63 cases(16.58%),skin yellow,eye yellow,urine yellow in 41 cases(10.79%),hematemesis in 10 cases(2.63%),weight loss in 8 cases(2.11%).4.Among 380 patients with HBV and HCV related HCC,the Child-Pugh grading scores of liver reserve function were as follows:159(41.84%)patients with Child-Pugh A,145(38.16%)patients with Child-Pugh B and 76(20.00%)patients with Child-Pugh C.Among the 328 patients with HBV related HCC,139(42.38%),123(37,50%)and 66(20.12%)were grade A,B and C,respectively;among the 52 patients with HCV related HCC,20(38.46%),22(42.31%)and 10(19.23%)were grade A,B and C,respectively.There was no significant difference between the two groups in the Child-Pugh score of liver reserve function(?2=0.454,P=0.797)(P>0.05).Among 380 patients with HBV and HCV related HCC,the BCLC stages of HCC were:stage 0 in 4(1.05%),stage A in 91(23.95%),stage B in 79(20.79%),stage C in 130(34.21%),and stage D in 76(20.00%).Among the 328 patients with HBV related HCC,stage 0,stage A,stage B,stage C and stage D were 4(1.22%),74(22.56%),66(20.12%),118(35.98%)and 66(20.12%),respectively;52 In patients with HCV related HCC,0 stage,A stage,B stage,C stage and D stage were:0 stage(0.00%),17 stage A(32.69%),13 stage B(25.00%),12 stage C(23.08%)and 10 stage D(19.23%).Based on the small number of cases in phase 0,they were included in phase a for statistical analysis.The results showed that there was no statistical difference between the two groups in the BCLC stage of HCC(?2=4.140,P=0.247)(P>0.05).5.The distribution of AFP in 380 patients with HCC:AFP<20?g in 71(18.68%);20?g?AFP<400 ?g in 109(28.68%);400??AFP<1000?g in 115(30.26%);AFP?1000 ?g in 85(22.38%).Correlation analysis between antiviral treatment and serum AFP level:compared with the control group,there was no statistical difference in the distribution of serum AFP level(?2=4.127,P=0.248)(P>0.05);compared with the control group,there was no statistical difference in the distribution of serum AFP level(?2=5.545,P=0.1142)(P>0.05).There was no correlation between AFP level and tumor number(rs=0.080,P=-0.119),extrahepatic metastasis(rs=0.098,P=0.057)(P>0.05).However,there was a positive correlation with tumor maximum diameter(rs=0.193,P=0.000),PVTT formation(rs=0.232,P=0.000),BCLC stage of liver cancer(rs=0.121,P=0.018)(all P<0.05).6.Among the patients with HBV related HCC,84(25.61%)were HBeAg positive and 244(74.39%)were HBeAg negative.Among 52 HCV related HCC cases,17 cases had definite HCV genotyping data.Among them,6 cases were type 1b(35.29%),3 cases were type 2a(17.65%),1 case was type 3a(5.88%),7 cases were type 3b(41.18%).7.Of the 328 patients with HBV related HCC,118 received antiviral therapy,including 102 patients receiving NAs antiviral therapy(LAM 14,ADV21,LDT4,ETV46,LAM combined with ADV11,TDF4);1 patient(0.85%)was treated with interferon alone;10(8.47%)was treated with Peg-IFNaalone;5(4.24%)was treated with Peg-IFNacombined with NAs.210 patients who did not receive antiviral therapy were set as control group.There was no statistical difference in APTT(Z=-1.417,P=0.156)between the treatment group and the control group(P>0.05),but in ALB(Z=-4.469,P=0.000),ALT(Z=-4.469,P=0.000),ALT(Z=-3.113,P=0.002),AST(Z=-5.834,P=0.000),ALP(Z=-4.651,P=0.000),TBIL(Z=-3.706,P=0.000),?-GGT(Z=-5.954,P=0.000),PT(Z=-3.479,P=0.000),There were statistically significant differences in all the indexes(P<0.05).The number of tumor(?=24.939,P=0.000),the maximum diameter of tumor(?2=42.081,P=0.000),the formation of portal vein tumor thrombus(?2=31.221,P=0.000),extrahepatic metastasis(?2=10.474,P=0.001),Child-Pugh grading score of liver reserve function(?2=25.381,P=0.000),BCLC stage of liver cancer(?2=62.282,P=0.000),There were statistically significant differences(P<0.05).8.Among 52 cases of HCV related HCC,23 cases were treated with antiviral therapy in the past,including 11 cases of DAA(7 cases of sophibvir,2 cases of sophibvir combined with dacatavir,2 cases of sophibvir/vpatavir),12 cases of pegifn a combined with ribavirin,and 29 cases of control group.The results showed that ALB(t=2.970,P=0.005),ALT(Z=-3.013,P=0.005),ALT(Z=-3.013,P=0.005),AST(Z=-3.012,P=0.003),ALP(Z=-2.036,P=0.042),PT(t=-2.071,P=0.044),APTT(Z=-2.392,P=0.021)and other indicators were statistically different(P<0.05),but there was no statistical difference in TB(Z=-0.369,P=0.712),?-GGT(Z=-0.765,P=0.444)(P>0.05).The comparison of imaging data between the two groups showed that there were statistical differences in the number of intrahepatic tumors(?2=6.766,P=0.034)and the formation of portal vein tumor thrombus(?2=4.388,P=0.036)(P<0.05),while there were no statistical differences in the maximum tumor diameter(?2=3.106,P=0.212)and extrahepatic metastasis(P=0.714)(P>0.05).There were significant differences in child Pugh score of liver reserve function(?2=6.024,P=0.049)and BCLC stage of liver cancer(?2=8.704,P=0.033)between the two groups(P<0.05).9.There were 61 cases(18.60%)with extrahepatic metastasis and 267 cases(81.40%)without extrahepatic metastasis.The patients in the two groups had drinking history(?2=5.775,P=0.016),liver reserve function child Pugh grading score(?2=12.249,P=0.020),tumor number(?2=34.652,P=0.000),tumor maximum diameter(?2=18.366,P=0.000),portal vein invasion(?2=35.579,P=0.000),antiviral treatment(?2=10.474,P=0.000),HBV-DNA(?2=18.775,P=0.000).The results showed that tumor number(OR=2.082,95%Cl:1.326-3.270,P=0.001)and portal vein invasion(OR=2.447,95%CI:1.084-5.524,P=0.031)were independent risk factors for extrahepatic metastasis of HBV related HCC.ROC curve analysis was performed again for the number of tumor and portal vein invasion.The results showed that the number of tumor(AUC=0.713,95%CI:0.645-0.782,P=0.000)and portal vein invasion(AUC=0.707,95%CI:0.638-0.779,P=0.000)could significantly predict the occurrence of HCC extrahepatic metastasis.10.After the interventional therapy of HCC,7 patients were treated with Peg-IFNa combined with immunomodulator as the observation group,8 patients were treated with anti-virus therapy of NAs only,and 8 patients were treated with anti-virus therapy of NAs after the interventional therapy of HCC as the control group.The median follow-up time was 29.5 months.At the end of follow-up,there were 2 cases(28.57%)of HCC recurrence in the observation group and 6 cases(75.00%)in the control group.The median disease-free survival time of the observation group was 49.43 months[95%CI(32.34,66.52)months],and that of the control group was 20.38 months[95%CI(15.88,24.87)months].There was statistical difference in disease-free survival time between the two groups(P=0.025).Conclusion(s):1.The majority of HBV and HCV related HCC patients are middle-aged male patients,the 40-59-year-old people belong to the high incidence group;they are significantly prevalent in low-level education and low-income groups;the risk of HCC will increase after menopause for women.In addition,the incidence of diabetes in HCV related HCC was significantly higher than that in HBV related HCC.Most of the clinical manifestations were abdominal pain,abdominal distention,asthenia,poor appetite,skin yellow,eye yellow,urine yellow and upper gastrointestinal hemorrhage.2.The increase of serum AFP level was positively correlated with the larger tumor diameter,the formation of portal vein tumor thrombus and the stage of BCLC in the later stage of liver cancer.3.Patients who have received antiviral treatment before show better prognosis when they have HCC4.Portal vein invasion and multiple intrahepatic tumors are independent risk factors for extrahepatic metastasis of HBV related HCC.5.Peg-IFNa combined with thymus method can significantly prolong the disease-free survival of patients after HBV related HCC intervention. |
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