CAJ | 학술논문

目的探讨自身免疫性肝炎(AIH)相关肝癌(HCC)的临床特点和预后危险因素.方法回顾解放军三零二医院2008年5月1日至2013年4月30日收治的40例AIH相关肝癌患者临床资料,分析AIH-HCC患者的临床特点和预后危险因素.结果 40例AIH-HCC患者确诊肝癌时的年龄28～ 76岁不等,平均(55.1±13.5)岁.AIH肝硬化患者发展为肝癌的时间间隔为(49.2±44.5)个月(范围3～ 194个月).AIH-HCC患者的中位生存期为(16.0±4.0)个月(范围1～44个月),1年生存率为54.0％.单因素分析显示AFP水平较高、肿瘤直径较大、肿瘤个数较多与患者预后较差有关(P＜0.05);而性别、年龄、IAIHG评分、AIH分型、输血史、饮酒史、吸烟史对患者生存期无明显影响(P＞0.05).多因素回归分析结果表明,AFP水平及肿瘤个数为影响预后的独立危险因素.对比多种治疗方案,绝大多数患者接受了肝动脉化疗栓塞治疗,但接受外科手术的患者生存率明显高于TACE或保守治疗.结论肝硬化是AIH患者发展为肝癌必然经历的过程.肝硬化后的每年肝癌发生率为1.65％.AFP阴性、肿瘤单发的AIH-HCC患者预后较好.与其他方法比较,外科手术治疗可以延长患者生存时间.
목적 탐토자신면역성간염(AIH)상관간암(HCC)적림상특점화예후위험인소.방법 회고해방군삼령이의원2008년5월1일지2013년4월30일수치적40례AIH상관간암환자림상자료,분석AIH-HCC환자적림상특점화예후위험인소.결과 40례AIH-HCC환자학진간암시적년령28～ 76세불등,평균(55.1±13.5)세.AIH간경화환자발전위간암적시간간격위(49.2±44.5)개월(범위3～ 194개월).AIH-HCC환자적중위생존기위(16.0±4.0)개월(범위1～44개월),1년생존솔위54.0％.단인소분석현시AFP수평교고、종류직경교대、종류개수교다여환자예후교차유관(P＜0.05);이성별、년령、IAIHG평분、AIH분형、수혈사、음주사、흡연사대환자생존기무명현영향(P＞0.05).다인소회귀분석결과표명,AFP수평급종류개수위영향예후적독립위험인소.대비다충치료방안,절대다수환자접수료간동맥화료전새치료,단접수외과수술적환자생존솔명현고우TACE혹보수치료.결론 간경화시AIH환자발전위간암필연경력적과정.간경화후적매년간암발생솔위1.65％.AFP음성、종류단발적AIH-HCC환자예후교호.여기타방법비교,외과수술치료가이연장환자생존시간.
Objective To study the clinical features and prognostic risk factors of patients with autoimmune hepatitis-related hepatocellular carcinoma (AIH-HCC).Methods We reviewed the clinical data of 40 patients with AIH-HCC who were treated at the 302 Hospital between May 1,2008 and April 30,2013,and analyzed the clinical characteristics and prognostic risk factors of these patients.Results These patients were diagnosed to have HCC at a mean ± SD of 55.1 ± 13.5 years (range 28-76 years).The median duration from the time of confirmed cirrhosis to a diagnosis of HCC was 49.2 ± 44.5 months (range 3-194 months).The median survival of the AIH-HCC patients was 16.0 ±4.0 months (range 1-44 months),and the 1-year survival rate was 54.0％.Univariate analysis showed AFP,tumor size,tumor number were related to prognosis (P ＜ 0.05) ; while gender,age,IAIHG score,category,history of blood transfusion,alcohol-drinking and smoking did not significantly affect the patients' survival (P ＞ 0.05).Multivariate regression analysis showed AFP and tumor number were independent prognostic factors.Most of these patients received transcatheter arterial chemoembolization(TACE),however the survival rate of those patients who received hepatectomy was significantly higher than those who received TACE or accepted conservative treatment.Conclusion Liver cirrhosis in AIH is the sine qua non for HCC development,which subsequently occurs at a rate of 1.65％ per year.Patients who had AFP-negativity or a single tumor had a better prognosis.Surgical treatment prolonged survival.