CAJ | 학술논문

目的探讨隐源性肝细胞癌（肝癌）的临床特点及预后。方法回顾性分析2001年1月至2012年12月在中山大学附属第三医院接受诊治的177例隐源性肝癌患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定。其中男138例，女39例；年龄30～82岁，中位年龄56岁。收集患者临床特征资料，调查HBV血清学标志物分布情况。根据不同的治疗方式将患者分为手术切除组（24例）、综合治疗组（88例）和保守治疗组（65例），比较3种治疗方法对患者生存率的影响。结果177例患者中男女比约为4∶1，年龄>60岁者占48.0%（85/177）；合并肝硬化者占90.4%（160/177），合并非酒精性脂肪性肝病、糖尿病者分别占19.2%（34/177）和21.5%（38/177）；抗-HBc阳性者占70.6%（125/177），AFP>400μg/L者占31.6%（56/177）；肝功能Child-Pugh分级A级占62.7%（111/177）；肿瘤直径≤5 cm者占35.6%（63/177），肿瘤单发者占54.2%（96/177）；巴塞罗那临床肝癌（BCLC）分期A期占9.6%（17/177）， B～D期占90.4%（160/177）。手术切除组患者1年生存率为92%，综合治疗组为65%，保守治疗组仅为8%。结论隐匿性HBV感染可能是隐源性肝癌的主要病因，非酒精性脂肪性肝病及糖尿病也可能对发病起重要作用。隐源性肝癌多发生在肝硬化基础之上，就诊时常常为中晚期，治疗效果及预后不佳，定期随访、早期诊断是改善预后的关键。
목적탐토은원성간세포암（간암）적림상특점급예후。방법회고성분석2001년1월지2012년12월재중산대학부속제삼의원접수진치적177례은원성간암환자림상자료。소유환자균첨서지정동의서，부합의학윤리학규정。기중남138례，녀39례；년령30～82세，중위년령56세。수집환자림상특정자료，조사HBV혈청학표지물분포정황。근거불동적치료방식장환자분위수술절제조（24례）、종합치료조（88례）화보수치료조（65례），비교3충치료방법대환자생존솔적영향。결과177례환자중남녀비약위4∶1，년령>60세자점48.0%（85/177）；합병간경화자점90.4%（160/177），합병비주정성지방성간병、당뇨병자분별점19.2%（34/177）화21.5%（38/177）；항-HBc양성자점70.6%（125/177），AFP>400μg/L자점31.6%（56/177）；간공능Child-Pugh분급A급점62.7%（111/177）；종류직경≤5 cm자점35.6%（63/177），종류단발자점54.2%（96/177）；파새라나림상간암（BCLC）분기A기점9.6%（17/177）， B～D기점90.4%（160/177）。수술절제조환자1년생존솔위92%，종합치료조위65%，보수치료조부위8%。결론은닉성HBV감염가능시은원성간암적주요병인，비주정성지방성간병급당뇨병야가능대발병기중요작용。은원성간암다발생재간경화기출지상，취진시상상위중만기，치료효과급예후불가，정기수방、조기진단시개선예후적관건。
ObjectiveTo investigate the clinical characteristics and prognosis of cryptogenic hepatocellular carcinoma (HCC).MethodsClinical data of 177 patients who were diagnosed with cryptogenic HCC in the Third Afifliated Hospital of Sun Yat-sen University from January 2001 to December 2012 were analyzed retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. There were 138 males and 39 females with age ranging from 30 to 82 years old and median age of 56 years old. Data of clinical characteristics were collected and hepatitis B virus (HBV) serological markers were investigated. According to the different treatments, the patients were divided into surgical resection group (n=24), comprehensive treatment group (n=88), and conservative treatment group (n=65). Impacts of these 3 treatments on the survival of patients were compared.ResultsOf the 177 patients, the ratio of male to female was about 4:1. Patients with age over 60 accounted for 48.0% (85/177), liver cirrhosis 90.4% (160/177), non-alcoholic fatty liver disease (NAFLD) 19.2% (34/177), diabetes mellitus (DM) 21.5% (38/177). Patients with positive hepatitis B virus core antibody (HBcAb) accounted for 70.6% (125/177), alpha fetal protein (AFP) >400 μg/L 31.6% (56/177), liver function Child-Pugh grade A 62.7% (111/177), tumor diameter≤5 cm 35.6% (63/177), single tumor 54.2% (96/177), Barcelona Clinic Liver Cancer (BCLC) stage A 9.6% (17/177), stage B-D 90.4% (160/177). The 1-year survival rate was 92% in surgical resection group, 65% in comprehensive treatment group, but only 8% in conservative group.ConclusionsOccult HBV infection may be the main cause of cryptogenic HCC, though NAFLD and DM may also play an important role in its occurrence. Cryptogenic HCC most occurs on the basis of liver cirrhosis and is usually found at an middle or advanced stage during the initial diagnosis. The treatment outcomes and prognosis are poor so regular follow-up, early diagnosis are the key to improve the prognosis.