伴癌综合征对肝切除术的肝细胞癌患者预后的影响
发布时间：2018-02-28 02:39
本文关键词： 肝细胞癌 伴癌综合征 肝切除术 预后 出处：《广西医科大学》2017年硕士论文 论文类型：学位论文
【摘要】：目的:探讨对于能手术切除的肝细胞癌(Hepatocellular carcinoma,HCC)患者,在基线资料保持一致的条件下,伴癌综合征(paraneoplastic syndromes,PNS)与HCC患者预后的关系。方法:来自广西医科大学附属肿瘤医院的1446名HCC病人,其中合并伴癌综合征的患者271名,应用倾向匹配得分法消除混杂因素后得到266对患者。根据资料类型采用相应的统计方法,对符合正态或近似正态分布的资料用?x±s描述,非正态分布的资料用M(Q1-Q3),两组间均数比较用t检验,分类变量的比较用χ2检验,生存率分析用Kaplan-Meier法估计,两组间差异用log-rank检验比较,独立预后因素的分析用COX回归分析。结果:在匹配前,1446名病人中有271名病人(18.7%)出现PNS。HCC合并PNS患者具有年龄更小、肿瘤直径更大、甲胎蛋白水平(AFP)更高等特点。在累积生存率的比较中,匹配前,PNS组患者的中位生存时间为51±8.3月,较非PNS组的64±8.1月的中位生存时间明显缩短(P=0.0064)。匹配后,PNS组患者的中位生存时间为42.0±7.3月,较非PNS组患者21.0±2.0月的中位生存时间明显延长(P0.001)。对各种PNS的临床表现分组分析,匹配前,低血糖血症患者的累积生存时间较非伴癌综合征患者缩短(27.0月VS 64.0月,P0.001),红细胞增多症、高血小板血症的累积生存时间与非伴癌综合征患者相比并没有统计学意义。匹配后,低血糖血症患者的累积生存时间与非伴癌综合征患者累积生存时间的比较没有统计学意义(27.0月VS 20.0月,P=0.1827),红细胞增多症患者的累积生存时间明显较非伴癌综合征患者的累积生存时间长(70.0月VS 21.0月,P=0.0008)。围手术期红细胞增高症的输血率(10.3%)明显低于非PNS组患者的输血率(26.8%)。单因素分析结果显示PNS、门静脉癌栓、肿瘤直径≥10cm、BCLC-C期、红细胞增多症为影响HCC患者术后累积生存率的高危因素。COX多因素分析显示:BCLC-C期肿瘤直径10cm是影响HCC患者总生存时间的独立危险因素,而PNS红细胞增多症独立保护性因素。结论:对于能手术切除的HCC患者,在肿瘤负荷相近的条件下,合并PNS患者较非PNS的患者预后更好,因此对于合并PNS的患者更应积极手术切除。
[Abstract]:Objective: to investigate the relationship between paraneoplastic syndromes (PNSs) and prognosis of patients with HCC under the condition that the baseline data of HCC patients with resectable hepatocellular carcinoma (HCC) were consistent. Methods: 1 446 HCC patients from the Cancer Hospital affiliated to Guangxi Medical University were enrolled in this study. Among the 271 patients with cancer syndrome, 266 pairs of patients were obtained by using the tendency matching score method to eliminate the confounding factors. According to the data type, the corresponding statistical method was used for the data that accord with normal distribution or approximate normal distribution. X 卤s was used to describe the data of non-normal distribution, t test was used to compare the mean of the two groups, 蠂 2 test was used to compare the classification variables, Kaplan-Meier method was used to estimate the survival rate, and log-rank test was used to compare the differences between the two groups. COX regression analysis was used to analyze the independent prognostic factors. Results: 271 of 1446 patients with PNS.HCC and PNS had younger age and larger tumor diameter. In the comparison of cumulative survival rate, the median survival time of PNS group was 51 卤8.3 months. The median survival time of PNS group was significantly shorter than that of non-PNS group (64 卤8.1 months). The median survival time of PNS group was 42.0 卤7.3 months, which was significantly longer than that of non-#en1# group (21.0 卤2.0 months). The cumulative survival time of patients with hypoglycemia was shorter than that of patients without cancer syndrome (27.0 months vs 64.0 months, P 0.001). The cumulative survival time of patients with polycythemia and hyperplatinemia was not significantly different from that of patients without cancer syndrome. There was no significant difference in cumulative survival time between patients with hypoglycemia and patients without cancer syndrome (27.0 vs 20.0month, P < 0.1827). The cumulative survival time of patients with polycythemia was significantly higher than that of patients without cancer syndrome. The cumulative survival time of the patients (70. 0 months vs 21. 0 months P0. 0008%) was significantly lower than that of non-PNS patients (10. 3%). The results of univariate analysis showed that PNS, portal vein tumor thrombus, and portal vein tumor thrombus were significantly lower than those in non-PNS group. Tumor diameter 鈮，
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