非HBV和HCV相关性肝细胞癌患者临床特征及预后影响因素分析

摘要/Abstract

摘要： 目的了解非HBV、HCV相关性肝细胞癌(NBNC-HCC)的临床特征及预后。方法 2010年1月至2017年6月解放军总医院第三医学中心收治的HCC患者94例。其中血清HBsAg、抗-HCV均为阴性HCC患者26例(NBNC-HCC组);血清HBsAg或抗-HCV为阳性HCC患者68例(非NBNC-HCC组)。多因素Logistic回归分析NBNC-HCC发生的影响因素。结果 NBNC-HCC组患者年龄(69.7±12.3)岁, 非NBNC-HCC组年龄(62.4±8.3)岁, 差异有统计学意义(t=12.40, P<0.05);NBNC-HCC组患者AFP 90.5(65.8, 234.0)ng/mL, 非NBNC-HCC组AFP 219. 5(95.0, 318.3)ng/mL, 差异有统计学意义(Z=13.83, P<0.05);NBNC-HCC组患者ALT(26.6±14.7)U/L, 非NBNC-HCC组ALT(38.5±1.7)U/L, 差异有统计学意义(t=5.41, P<0.05);NBNC-HCC组患者Child-Pugh A级23例(88.5%), Child-Pugh B级3例(11.5%), 非NBNC-HCC组患者Child-Pugh A级46例(67.6%), Child-Pugh B级22例(32.4%), 差异有统计学意义(χ²=4.17, P<0.05);NBNC-HCC组患者有血管侵犯3例(11.5%), 无血管侵犯23例(88.5%);非NBNC-HCC组患者有血管侵犯29例(42.6%), 无血管侵犯39例(57.4%), 差异有统计学意义(χ²=8.11, P<0.05);NBNC-HCC组患者肿瘤边界界清17例(65.4%), 肿瘤边界界不清9例(34.6%);非NBNC-HCC组患者肿瘤边界界清17例(25.0%), 肿瘤边界界不清51例(75.0%), 差异有统计学意义(χ²=13.29, P<0.05);NBNC-HCC组患者有肿瘤包膜22例(84.6%), 无肿瘤包膜4例(15.4%);非NBNC-HCC组患者有肿瘤包膜32例(47.1%), 无肿瘤包膜36例(52.9%), 差异有统计学意义(χ²=10.85, P<0.05)。多因素logistic回归分析得出AFP、Child-Pugh分级、血管侵犯、肿瘤边界及肿瘤包膜是NBNC-HCC发生的独立危险因素。结论 AFP、Child-Pugh分级、血管侵犯、肿瘤边界及肿瘤包膜是影响NBNC-HCC发生的独立危险因素。

Abstract: Objective The clinical features and prognostic data of non-hepatitis B and non- hepatitis C related hepatocellular carcinoma (NBNC-HCC) were retrospectively analyzed in order to provide references for the treatment strategies on NBNC-HCC patients.Methods A total of 94 patients (69 males and 25 females) with HCC were collected from January 2010 to June 2017, with an average age of 65.3±9.6 years. Twenty-six patients that were negative in serum HBsAg and HCV antibody (Ab) were grouped in NBNC-HCC group, including 19 males and 7 females. Sixty-eight patients that were positive in serum HBsAg or HCV Ab were grouped in non-NBNC-HCC group, with 50 males and 18 females. Multivariate Logistic regression analysis was used to explore the influencing factors of NBNC-HCC. Results The clinical data of NBNC-HCC group and non-NBNC-HCC group were compared. The average age of patients in NBNC-HCC group was (69.7±12.3) years old, while that in non-NBNC-HCC group was (62.4±8.3) years old. The difference was statistically significant (P<0.05). The alpha-fetoprotein (AFP) level in the patients of NBNC-HCC group 90.5 (65.8, 234.0) ng/mL were significant lower than that of the non-NBNC-HCC group 219. 5(95.0, 318.3) ng/mL(P<0.05). The ALT level in NBNC-HCC group (26.6±14.7) U/L were also different with that of the non-NBNC-HCC group (38.5±1.7) U/L (P<0.05). In NBNC-HCC group, 23 patients (88.5%) were Child-Pugh grade A, 3 patients (11.5%) were Child-Pugh grade B, while in NBNC-HCC group, 46 patients (67.6%) were Child-Pugh grade A, and 22 patients (32.4%) were Child-Pugh B, the difference was statistically significant (P<0.05). In NBNC-HCC group, there were 3 cases (11.5%) with vascular invasion and 23 cases (88.5%) without vascular invasion, while in non-NBNC-HCC group, there were 29 cases (42.6%) with vascular invasion and 39 cases (57.4%) without vascular invasion, the difference was statistically significant (P<0.05). In NBNC-HCC group, tumor boundary was clear in 17 cases (65.4%) and unclear in 9 cases (34.6%), while in non-NBNC-HCC group, tumor boundary was clear in 17 cases (25.0%) and unclear in 51 cases (75.0%), the difference was statistically significant (P<0.05). In NBNC-HCC group, there were 22 cases (84.6%) with tumor capsule and 4 cases (15.4%) without tumor capsule, while in non-NBNC-HCC group, there were 32 patients (47.1%) with tumor capsule and 36 patients (52.9%) without tumor capsule, the difference was statistically significant (P<0.05). Multivariate Logistic regression analysis showed that AFP, Child-Pugh grade, vascular invasion, tumor boundary and tumor capsule were independent risk factors for NBNC-HCC.Conclusion AFP, Child-Pugh grade, vascular invasion, tumor boundary and tumor capsule were independent risk factors for NBNC-HCC. The 3-year survival rate of NBNC-HCC patients was higher than that of non-NBNC-HCC patients.

Key words: non-hepatitis B and non- hepatitis C related hepatocellular carcinoma, α-fetoprotein, Child-Pugh classification, Logistic regression analysis

苏丹, 张伟伟. 非HBV和HCV相关性肝细胞癌患者临床特征及预后影响因素分析[J]. 肝脏, 2021, 26(4): 384-387.

SU Dan, ZHANG Wei-wei. An analysis of clinical characteristics and prognostic factors of patients with non-HBV and non-HCV related hepatocellular carcinoma[J]. Chinese Hepatolgy, 2021, 26(4): 384-387.

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