CAJ | 학술논문

目的：分析乙型肝炎病毒相关原发性肝癌（HBV-PLC）患者生存期及其影响因素。方法收集2011年11月至2014年6月我院119例HBV-PLC患者临床资料，应用Kaplan-Meier检验及Cox回归模型，分析影响HBV-PLC患者生存期的因素。结果在119例HBV-PLC患者中，终末期肝癌比例较高，BCLC D期患者41例（34.5%），Child-Pugh C级79例（66.4%），伴有基础疾病78例（65.5%），肿瘤肝内或肝外转移90例（75.6%），患者中位生存期为287（172，560） d；在HBV-PLC确诊前未抗病毒治疗、抗病毒治疗持续时间＜1年、1～3年和＞3年患者的中位生存期分别为232（114，390） d、357（179，879） d、530（206，-） d和795（384，912）d（P＜0.01）；Cox回归分析提示，民族、Child-Pugh分级、肿瘤转移、年龄、抗病毒治疗、血清HBV DNA水平和肿瘤治疗方式是预测患者生存期的重要因素，相对危险度分别为3.18、1.60、4.86、1.82、1.30、5.88和1.13（P＜0.05或P＜0.01）。结论影响HBV-PLC患者生存期的因素很多，早期监测、早期干预、规范抗肿瘤治疗将有助于延长HBV-PLC患者的生存期。
목적：분석을형간염병독상관원발성간암（HBV-PLC）환자생존기급기영향인소。방법수집2011년11월지2014년6월아원119례HBV-PLC환자림상자료，응용Kaplan-Meier검험급Cox회귀모형，분석영향HBV-PLC환자생존기적인소。결과재119례HBV-PLC환자중，종말기간암비례교고，BCLC D기환자41례（34.5%），Child-Pugh C급79례（66.4%），반유기출질병78례（65.5%），종류간내혹간외전이90례（75.6%），환자중위생존기위287（172，560） d；재HBV-PLC학진전미항병독치료、항병독치료지속시간＜1년、1～3년화＞3년환자적중위생존기분별위232（114，390） d、357（179，879） d、530（206，-） d화795（384，912）d（P＜0.01）；Cox회귀분석제시，민족、Child-Pugh분급、종류전이、년령、항병독치료、혈청HBV DNA수평화종류치료방식시예측환자생존기적중요인소，상대위험도분별위3.18、1.60、4.86、1.82、1.30、5.88화1.13（P＜0.05혹P＜0.01）。결론영향HBV-PLC환자생존기적인소흔다，조기감측、조기간예、규범항종류치료장유조우연장HBV-PLC환자적생존기。
Objective To clarify the prognostic factors that influence the overall survival (OS)in patients with hepatitis B virus-related primary liver carcer (HBV-PLC). Methods The clinical data of 119 patients with HBV-PLC from November 2011 to June 2014 in our hospital were retrospectively reviewed,and OS was analyzed by using Kaplan-Meier method,Log-rank test and Cox proportional hazard model. Results There were 41 cases (34.5%) with terminal stage of tumor [Barcelona Clinic Liver Cancer (BCLC)stage D ],79 (66.4%) with Child-Pugh class C,78(65.5%) with pre-existing diseases,and 90(75.6%) with tumor metastasis among the 119 patients with HBV-PLC;The median overall survival in this series was 287 (172,560) days,and the median overall survivals of patients with non-antiviral therapy,with antiviral therapy for less than one year,with antiviral therapy for one to three years,and with antiviral therapy for more than 3 years were 232 (114,390) days,357(179,879) days,530 (206-)days,and 795(384,912) days (P<0.01);The Cox proportional-hazards model demonstrated that nationality [relative risk(RR)=3.18,95% CI,1.71~5.91,P=0.000],Child-Pugh class(RR=1.60,95%CI,1.180~2.16, P=0.002),tumor metastasis (RR=4.86,95%CI,2.72~8.68,P=0.000),age (RR=1.82,95%CI,1.13~2.95,P=0.014), antiviral therapy prior to diagnosis of HBV-PLC (RR=1.30,95%CI,1.00~1.69,P=0.048),serum HBV DNA level (RR=5.88,95%CI,3.22~10.71,P=0.000)and the way targeting tumor therapy (RR=1.13,95%CI,1.01~1.26,P=0.025) were significant predictor of overall survival. Conclusion Many factors might influence the overall survival of patients with HBV-PLC,and the rigorous screening and surveillance in the HBV-infected populations, and effective antiviral therapy for HBV infection are important for prolonging the life of patients with PLC.