Analysis Of The Clinical Characteristics Of 856 Patients With Middle And Late Stage Primary Liver Cancer In Minority Areas

Objective: To collect the clinical data of patients with middle stage and late stage primary liver cancer.To analyze the differences in clinical characteristics between middle stage and late stage patients.To explore the influence of different treatment methods on the prognosis of patients,so as to provide reference for the diagnosis and treatment of liver cancer in ethnic areas in the future.Methods: Clinical data of 856 primary liver cancer patients with middle or late stage hospitalized in the Affiliated Hospital of Youjiang Medical University for Nationalities from January 2016 to September 2019 were collected,which clinical data including general information,past medical history,reasons for previous visits,HBV virus,tumor markers,liver function indicators,Child-Pugh grade,portal vein cancer thrombus,treatment methods and overall survival time.(1)According to BCLC stage,the patients were divided into BCLC-B stage(middle stage,n=642)and BCLC-C stage(late stage,n=214).The differences in clinical characteristics between the two groups were analyzed.(2)Patients were divided into TACE group and non-TACE group according to whether they received TACE surgery.There were622 patients in the TACE group and 234 patients in the non-TACE group.The difference in postoperative survival between the two groups was compared.(3)According to different treatment methods,the patients were divided into 5 groups:(1)TACE group(n=297);(2)TACE+Sorafenib group(n=119);(3)TACE+ablation group(n=152);(4)Operation+TACE group(n=28);(5)Surgery+TACE+ablation group(n=26).The difference of postoperative survival time between the groups was compared.Results:(1)Between the middle and late stgae patients,there were no significant differences in onset age,male proportion,average BMI,average hospitalization times(P>0.05),and no significant differences in the history of smoking,family cancer,diabetes,HBV infection,HCV infection,fatty liver and cirrhosis(P > 0.05).(2)Compared with middle stage patients,The AFP,CEA,CA125 and CA199 positive rates were significantly higher in late stage patients;the levels of TBIL,ALT,AST,GGT and ALB were significantly increased;the proportion of Child-Pugh grade B patients was significantly increased;the proportion of portal vein tumor thrombus was significantly increased,and the difference was statistically significant(P<0.05).(3)The Effects of TACE treatment on patient survival time.(1)The survival rate at 6 and12 months in TACE patients was significantly higher than that in non-TACE patients,and the difference was statistically significant(P<0.05).(2)The survival rate at 6 and 12 months in the middle stage of TACE treatment was significantly higher than that in the late stage of TACE treatment,and the difference was statistically significant(P<0.05).(3)The survival rate at 6 and 12 months in the middle stage patients without TACE treatment was significantly higher than that in the late stage patients without TACE treatment,and the difference was statistically significant(P<0.05).(4)The 6-and 12-month survival rate of patients in the middle or late stage of TACE treatment was significantly higher than that of patients without TACE treatment at the same period,with statistical significance(P<0.05).(4)Effects of TACE in combination with other regimens on patient survival.(1)When TACE was combined with other regiments,the survival rates at 6 months and 12 months were significantly higher than that of TACE alone,with statistical significance(P < 0.05);(2)The3-month and 12-month survival rates of TACE+ surgery + ablation were significantly higher than those of other combined treatments,with statistical significance(P < 0.05).(5)The effect of TACE combined with other regimens on the survival time of patients in the middle stage and advanced stage:(1)For patients in the middle stage,the survival rate at 6and 12 months of TACE combined with other regimens was significantly higher than that of the TACE group alone,with statistical significance(P < 0.05);The 12-month survival rate in the surgery +TACE+ ablation group was significantly higher than that in the other combined treatment groups,with statistical significance(P<0.05).(2)For advanced patients,the12-month survival rate of TACE combined with other treatment regimens was significantly higher than that of TACE alone group,with statistical significance(P<0.05).The 12-month survival rate in the surgery +TACE+ ablation group was significantly higher than that in the other combined treatment groups,with statistical significance(P<0.05).(6)Age,hospitalization times,portal vein tumor thrombus,Child-Pugh and whether to receive TACE treatment are the main factors affecting the prognosis of patients with primary liver cancer.Conclusion: The proportion of patients with middle and advanced HCC is higher in males than in females,and the peak of HCC is 50～59 and 60～69.In terms of ethnic distribution,the most common patients are Zhuang and Han,and other ethnic groups include Buyi,Yao and Yi.There were significant differences in the positive rate of tumor markers and liver function indexes in the middle and advanced patients.Older age,less hospitalization,portal vein embolism,Child-Pugh grade B,and lack of TACE therapy were the risk factors for survival in patients with primary liver cancer.Aggressive TACE therapy,combined with targeted drug therapy,ablation therapy,and surgery,can improve survival in patients with advanced stages,especially those with advanced stages.