原发性肝癌患者生存预后及影响因素分析(附3106例报告)
Survival prognosis and influencing factors of patients with primary liver cancer: a report of 3 106 cases
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摘要:
目的:探讨原发性肝癌患者的生存预后及影响因素。
方法:采用回顾性描述性研究方法。收集2000年1月至2018年8月重庆市恶性肿瘤特病办理系统中3 106例有特殊病种医保原发性肝癌患者的临床病理资料；男2 559例，女547例；年龄为(60±13)岁，年龄范围为19～95岁。观察指标：(1)人口学特征。(2)临床治疗与病理学检查情况。(3)随访及生存情况。(4)预后影响因素分析。采用电话、门诊或住院复查方式进行随访，了解患者生存情况。随访时间为确诊后第1年每3个月随访1次，之后每年随访1次。随访时间截至2018年12月。正态分布的计量资料以
±s表示，偏态分布的计量资料以M(范围)表示。计数资料以绝对数和(或)百分比表示。剔除随访缺失数据后进行生存分析，采用Kaplan-Meier法计算生存率并绘制生存曲线。剔除随访缺失数据、病理学类型缺失数据、TNM分期缺失数据后进行预后影响因素分析，单因素分析采用Log-rank检验，多因素分析采用COX比例风险模型。
结果:(1)人口学特征：3 106例原发性肝癌患者性别(男、女)，年龄(<30岁、30～44岁、45～59岁、60～74岁、≥75岁)，民族(汉族、其他民族)，婚姻状况(已婚、其他)，职业［企业单位和(或)工人、事业单位和(或)公务员、自由职业和(或)个体户、无业人员、公司职员、其他职业］分别为2 559、547例，35、362、1 131、1 163、415例，3 053、 53例，2 896、210例，880、342、130、101、124、1 529例。(2)临床治疗与病理学检查情况：3 106例原发性肝癌患者住院治疗时间(<10 d、10～19 d、20～29 d、≥30 d)，手术治疗(无、有)，病理学类型(肝细胞癌、胆管细胞癌、混合型及其他)，TNM分期 (Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期)分别为771、1 312、661、362例，915、2 191例，836、63、24例，29、28、90、624例。3 106例患者中，病理学类型数据缺失2 183例，TNM分期数据缺失2 335例。(3)随访及生存情况：3 106例原发性肝癌患者中，2 561例获得随访，随访时间为3.0～96.0个月，中位随访时间为27.6个月。2 561例患者总体生存时间为1.0～96.0个月，中位总体生存时间为24.7个月，1、3、 5年总体生存率分别为63.2%、42.3%、29.5%。(4)预后影响因素分析：单因素分析结果显示年龄、婚姻状况、职业、住院治疗时间、手术治疗、病理学类型、TNM分期是患者预后的影响因素(x2=31.820，6.752，39.100，120.889，226.700，10.452，48.602，P<0.05)。多因素分析结果显示：已婚，住院治疗时间≥30 d，手术治疗是患者预后的独立保护因素(风险比=1.463，0.572，0.575，95%可信区间为1.044～2.049，0.413～0.793，0.438～0.755，P<0.05)，TNM分期Ⅲ期、Ⅳ期是患者预后的独立危险因素(风险比=3.941，5.036，95%可信区间为1.687～9.211，2.237～11.335，P<0.05)。
结论:原发性肝癌患者预后较差；已婚，住院治疗时间≥30 d，手术治疗是患者预后的独立保护因素；TNM分期Ⅲ期、Ⅳ期是患者预后的独立危险因素。Abstract:Objective:To investigate the survival prognosis of patients with primary liver cancer and its influencing factors.
Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 3 106 patients with primary liver cancer who had health insurance for special illness in the Chongqing Malignant Tumor Treatment System from January 2000 to August 2018 were collected. There were 2 559 males and 547 females, aged (60±13)years, with a range from 19 to 95 years. Observation indicators: (1) demographic characteristics; (2) clinical treatment and pathological examination; (3) Follow-up and survival; (4) analysis of prognostic factors. Follow-up using telephone interview, outpatient or inpatient reexamination was preformed to detect survival of patients. Follow-up was done once every 3 months within the first year and once a year thereafter up to December 2018. Measurement data with normal distribution were represented as Mean±SD. Measurement data with skewed distribution were represent as M (range). Count data were expressed as absolute numbers or percentages. Survival analysis was done after excluding missing data of Follow-up. The survival rate was calculated and survival curve was drawn by Kaplan-Meier method. The prognostic factors were analyzed after excluding missing data of Follow-up, pathological type, and TNM staging. The logrank test was used for univariate analysis, and COX proportional hazard model was used for multivariate analysis.
Results:(1) Demographic characteristics: of the 3 106 patients with primary liver cancer, the number of males and females (gender), cases with age < 30 years, from 30 to 44 years, from 45 to 59 years, from 60 to 74 years, ≥75 years, cases of Han nationality or other ethnic groups, cases being married or other status (marital status), cases with occupation as enterprise unit staff and (or) workers, public institution personnel and (or) civil servants, freelancers and (or) selfemployed entrepreneurs, unemployed, company staff, and other professionals were 2 559, 547, 35, 362, 1 131, 1 163, 415, 3 053, 53, 2 896, 210, 880, 342, 130, 101, 124, and 1 529, respectively. (2) Clinical treatment and pathological examination: of the 3 106 patients with primary liver cancer, cases with hospitalization time < 10 days, from 10 to 19 days, from 20 to 29 days, ≥30 days, cases without surgery or with surgery, cases with hepatocellular carcinoma, cholangiocarcinoma, hybrid type and other pathological types, cases of stage Ⅰ, Ⅱ, Ⅲ, Ⅳ of TNM staging were respectively 771, 1 312, 661, 362, 915, 2 191, 836, 63, 24, 29, 28, 90, 624. There were 2 183 out of 3 106 patients without pathological data and 2 335 without TNM staging data. (3) Follow-up and survival: of the 3 106 patients with primary liver cancer, 2 561 were followed up for 3.0-96.0 months, with a median Follow-up time of 27.6 months. The 2 561 patients had survived for 1.0-96.0 months, with a median survival time of 24.7 months. The 1, 3, 5year survival rates were 63.2%, 42.3%, 29.5%, respectively. (4) Analysis of prognostic factors: results of univariate analysis showed that age, marital status, occupation, hospitalization time, surgical treatment, pathological types, and TNM staging were related factors for prognosis of patients (x2=31.820, 6.752, 39.100, 120.889, 226.700, 10.452, 48.602, P<0.05). Results of multivariate analysis showed that being married, hospitalization time no less than 30 days, surgical treatment were independent protective factors for prognosis (hazard ratio=1.463, 0.572, 0.575, 95% confidence interval: 1.044-2.049, 0.413-0.793, 0.438-0.755, P<0.05), stage Ⅲ and Ⅳ of TNM staging were independent risk factors for prognosis of patients (hazard ratio=3.941, 5.036, 95% confidence interval: 1.687-9.211, 2.237-11.335, P<0.05).
Conclusions:Patients with primary liver cancer have poor prognosis. Being married, hospitalization time no less than 30 days, and surgical treatment are independent protective factors for prognosis, stage Ⅲ and Ⅳ of TNM staging are independent risk factors for prognosis.-
Keywords:
- Hepatic neoplasms /
- Demographic survey /
- Follow-up /
- Prognosis /
- Influencing factor
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