原发性肝癌自发破裂出血患者近期及远期预后因素分析

doi:10.3877/cma.j.issn.2095-3232.2016.02.008

中华肝脏外科手术学电子杂志 ›› 2016, Vol. 05 ›› Issue (02) : 95 -100. doi: 10.3877/cma.j.issn.2095-3232.2016.02.008

所属专题：文献；

临床研究

原发性肝癌自发破裂出血患者近期及远期预后因素分析

钟锋¹^,^†(

), 程新生², 王金重³, 郭永学³, 何坤⁴, 孙世波⁵

^1. 518100　深圳，南方医科大学深圳医院肝胆外科
^2. 518052　深圳，广东医学院附属南山医院肝胆外科
^3. 529000　广东省江门市，南方医科大学附属江门医院肝胆外科
^4. 528400　广东省中山市，中山大学附属中山医院肝胆外科
^5. 510515　广州，南方医科大学南方医院肝胆外科

收稿日期:2015-12-15 出版日期:2016-04-10
通信作者: 钟锋

Analysis of short- and long-term prognostic factors for patients with spontaneous rupture and bleeding of primary liver cancer

Feng Zhong¹^,^†(), Xinsheng Cheng², Jinzhong Wang³, Yongxue Guo³, Kun He⁴, Shibo Sun⁵

^1. Department of Hepatobiliary Surgery, Shenzhen Hospital, Southern Medical University, Shenzhen 518100, China
^2. Department of Hepatobiliary Surgery, Nanshan Hospital, Guangdong Medical College, Shenzhen 518052, China
^3. Department of Hepatobiliary Surgery, Jiangmen Hospital, Southern Medical University, Jiangmen 529000, China
^4. Department of Hepatobiliary Surgery, Zhongshan Hospital, Sun Yat-sen University, Zhongshan 528400, China
^5. Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China

Received:2015-12-15 Published:2016-04-10
Corresponding author: Feng Zhong
About author:
Corresponding author: Zhong Feng, Email:zhf@zzu.edu.cn

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引用本文：

钟锋, 程新生, 王金重, 郭永学, 何坤, 孙世波. 原发性肝癌自发破裂出血患者近期及远期预后因素分析[J]. 中华肝脏外科手术学电子杂志, 2016, 05(02): 95-100.

Feng Zhong, Xinsheng Cheng, Jinzhong Wang, Yongxue Guo, Kun He, Shibo Sun. Analysis of short- and long-term prognostic factors for patients with spontaneous rupture and bleeding of primary liver cancer[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2016, 05(02): 95-100.

目的

探讨原发性肝癌（肝癌）自发破裂出血患者近期及远期预后的影响因素。

方法

回顾性分析2005年1月至2012年12月在南方医科大学附属江门医院及广东医学院附属南山医院接受治疗的167例肝癌自发破裂出血患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定。其中男140例，女27例，平均年龄（58±7）岁。肝功能Child-Pugh分级A级78例，B级44例，C级45例。肿瘤TNM分期Ⅱ期31例，Ⅲ期54例，ⅣA期73例，ⅣB期9例。分析患者30 d生存率及远期生存率。生存率影响因素分析采用Cox比例回归风险模型。

结果

患者30 d生存率为71.3%，1、3、5年累积生存率分别为40.1%、16.5%、5.4%。多因素Cox回归分析显示肝功能Child-Pugh分级C级、失血性休克、肿瘤数量≥2个、肿瘤TNM分期Ⅲ期和保守治疗为患者30 d生存率的独立危险因素（HR=9.503，2.919，4.760，0.283，32.004；P<0.05）。肝硬化、肝功能Child-Pugh分级C级、TB≥34 μmol/L、肿瘤数量≥2个、肿瘤TNM分期Ⅲ期和保守治疗为患者远期生存率的独立危险因素（HR=9.167，5.950，1.037，2.821，0.680，8.147；P<0.05）。

结论

肝功能Child-Pugh分级C级、失血性休克、肿瘤数量≥2个、肿瘤TNM分期Ⅲ期和保守治疗为肝癌自发破裂出血患者近期预后的独立危险因素。而肝硬化、肝功能Child-Pugh分级C级、TB≥34 μmol/L、失血性休克、肿瘤数量≥2个、肿瘤TNM分期Ⅲ期和保守治疗为其远期预后的独立危险因素。

关键词: 肝肿瘤, 破裂, 肝切除术, 预后, 回归分析

Objective

To investigate the short- and long-term prognostic factors for patients with spontaneous rupture and bleeding of primary liver cancer (liver cancer).

Methods

Clinical data of 167 patients with spontaneous rupture and bleeding of liver cancer admitted to Jiangmen Hospital, Southern Medical University and Nanshan Hospital, Guangdong Medical College between January 2005 and December 2012 were retrospectively analyzed. There were 140 males and 27 females with the average age of (58±7) years. The informed consents of all patients were obtained and the local ethical committee approval was received. Seventy-eight cases were diagnosed with Child-Pugh classification A, 44 with Child-Pugh classification B and 45 with Child-Pugh classification C. According to the tumor, node, metastasis (TNM) stage, 31 cases were in stage Ⅱ, 54 in stage Ⅲ, 73 in stage ⅣA and 9 in stage ⅣB. The 30-d and long-term survival rates were analyzed. The influencing factors of survival rates were analyzed by Cox's proportional hazard regression model.

Results

The 30-d survival rate was 71.3%, and the 1-, 3- , 5-year accumulative survival rate was 40.1%, 16.5%, 5.4% respectively. Multiviariate Cox's regression analysis revealed that Child-Pugh classification C, hypovolemic shock, number of tumors≥2, TNM stage Ⅲ and conservative therapy were the independent risk factors for 30-d survival rate (HR=9.503, 2.919, 4.760, 0.283, 32.004; P<0.05). Liver cirrhosis, Child-Pugh classification C, total bilirubin (TB)≥34 μmol/L, number of tumors≥2, TNM stage Ⅲ and conservative therapy were the independent risk factors for long-term survival rate (HR=9.167, 5.950, 1.037, 2.821, 0.680, 8.147; P<0.05).

Conclusions

For patients with spontaneous rupture and bleeding of liver cancer, Child-Pugh classification C, hypovolemic shock, number of tumors≥2, TNM stage Ⅲ and conservative therapy are the independent risk factors for short-term pronosis, whereas liver cirrhosis, Child-Pugh classification C, TB≥34 μmol/L, number of tumors≥2, TNM stage Ⅲ and conservative therapy are the independent risk factors for long-term pronosis.

Key words: Liver neoplasms, Rupture, Hepatectomy, Prognosis, Regression analysis

表1 影响肝癌自发破裂出血患者30 d生存率的单因素分析

参数	HR	95%CI	P值
年龄	0.992	0.952～1.035	0.718
性别	0.902	0.437～1.863	0.781
乙肝	0.602	0.256～1.416	0.245
肝硬化	27.084	1.076～681.926	0.045
肝功能Child-Pugh分级	6.289	3.841～10.297	<0.001
失血性休克	2.283	1.239～4.204	0.008
Hb	0.931	0.899～0.963	<0.001
Plt	0.986	0.969～1.004	0.124
INR	3.752	2.692～5.228	<0.001
ALB	0.814	0.760～0.872	<0.001
TB	1.065	1.049～1.081	<0.001
ALT	1.000	0.997～1.004	0.892
Scr	3.104	0.566～17.010	0.192
AFP	1.000	1.000～1.000	0.392
肿瘤直径	0.954	0.832～1.094	0.502
肿瘤数量	2.318	1.292～4.159	0.005
门静脉癌栓	0.879	0.477～1.619	0.680
肿瘤TNM分期	1.432	1.005～2.041	0.047
破裂出血位置	1.758	0.915～3.379	0.091
保守治疗	21.719	11.493～41.045	<0.001
TAE治疗	0.526	0.255～1.087	0.083
肝切除手术	0.106	0.055～0.204	<0.001

表1 影响肝癌自发破裂出血患者30 d生存率的单因素分析

参数	HR	95%CI	P值
年龄	0.992	0.952～1.035	0.718
性别	0.902	0.437～1.863	0.781
乙肝	0.602	0.256～1.416	0.245
肝硬化	27.084	1.076～681.926	0.045
肝功能Child-Pugh分级	6.289	3.841～10.297	<0.001
失血性休克	2.283	1.239～4.204	0.008
Hb	0.931	0.899～0.963	<0.001
Plt	0.986	0.969～1.004	0.124
INR	3.752	2.692～5.228	<0.001
ALB	0.814	0.760～0.872	<0.001
TB	1.065	1.049～1.081	<0.001
ALT	1.000	0.997～1.004	0.892
Scr	3.104	0.566～17.010	0.192
AFP	1.000	1.000～1.000	0.392
肿瘤直径	0.954	0.832～1.094	0.502
肿瘤数量	2.318	1.292～4.159	0.005
门静脉癌栓	0.879	0.477～1.619	0.680
肿瘤TNM分期	1.432	1.005～2.041	0.047
破裂出血位置	1.758	0.915～3.379	0.091
保守治疗	21.719	11.493～41.045	<0.001
TAE治疗	0.526	0.255～1.087	0.083
肝切除手术	0.106	0.055～0.204	<0.001

表2 影响肝癌自发破裂出血患者30 d生存率的多因素分析

参数	HR	95%CI	P值
肝功能Child-Pugh分级C级	9.503	4.763～18.961	<0.001
失血性休克	2.919	1.315～6.476	0.008
肿瘤数量≥2个	4.760	1.962～11.550	0.001
肿瘤TNM分期Ⅲ期	0.283	0.165～0.485	<0.001
保守治疗	32.004	13.535～75.679	<0.001

表2 影响肝癌自发破裂出血患者30 d生存率的多因素分析

参数	HR	95%CI	P值
肝功能Child-Pugh分级C级	9.503	4.763～18.961	<0.001
失血性休克	2.919	1.315～6.476	0.008
肿瘤数量≥2个	4.760	1.962～11.550	0.001
肿瘤TNM分期Ⅲ期	0.283	0.165～0.485	<0.001
保守治疗	32.004	13.535～75.679	<0.001

表3 影响肝癌自发破裂出血患者远期生存率的单因素分析

参数	HR	95%CI	P值
年龄	1.058	1.025～1.093	0.001
性别	0.748	0.479～1.166	0.199
乙肝	0.650	0.407～1.036	0.070
肝硬化	10.012	4.372～22.928	<0.001
肝功能Child-Pugh分级	6.118	4.491～8.335	<0.001
失血性休克	1.606	1.141～2.262	0.007
Hb	0.983	0.965～1.002	0.073
Plt	0.998	0.992～1.005	0.642
INR	3.569	2.630～4.843	<0.001
ALB	0.854	0.812～0.898	<0.001
TB	1.075	1.059～1.091	<0.001
ALT	1.003	1.001～1.006	0.001
Scr	1.847	0.733～4.656	0.193
AFP	1.000	1.000～1.000	0.639
肿瘤直径	1.003	0.930～1.083	0.934
肿瘤数量	1.632	1.161～2.293	0.005
门静脉癌栓	1.325	0.937～1.880	0.116
肿瘤TNM分期	1.577	1.267～1.962	<0.001
肝癌自发破裂出血位置	1.174	0.825～1.673	0.373
保守治疗	19.357	11.123～33.688	<0.001
TAE治疗	0.955	0.655～1.391	0.811
肝切除手术	0.187	0.129～0.272	<0.001

表3 影响肝癌自发破裂出血患者远期生存率的单因素分析

参数	HR	95%CI	P值
年龄	1.058	1.025～1.093	0.001
性别	0.748	0.479～1.166	0.199
乙肝	0.650	0.407～1.036	0.070
肝硬化	10.012	4.372～22.928	<0.001
肝功能Child-Pugh分级	6.118	4.491～8.335	<0.001
失血性休克	1.606	1.141～2.262	0.007
Hb	0.983	0.965～1.002	0.073
Plt	0.998	0.992～1.005	0.642
INR	3.569	2.630～4.843	<0.001
ALB	0.854	0.812～0.898	<0.001
TB	1.075	1.059～1.091	<0.001
ALT	1.003	1.001～1.006	0.001
Scr	1.847	0.733～4.656	0.193
AFP	1.000	1.000～1.000	0.639
肿瘤直径	1.003	0.930～1.083	0.934
肿瘤数量	1.632	1.161～2.293	0.005
门静脉癌栓	1.325	0.937～1.880	0.116
肿瘤TNM分期	1.577	1.267～1.962	<0.001
肝癌自发破裂出血位置	1.174	0.825～1.673	0.373
保守治疗	19.357	11.123～33.688	<0.001
TAE治疗	0.955	0.655～1.391	0.811
肝切除手术	0.187	0.129～0.272	<0.001

表4 影响肝癌自发破裂出血患者远期生存率的多因素分析

参数	HR	95%CI	P值
肝硬化	9.167	3.849～21.834	<0.001
肝功能Child-Pugh分级C级	5.950	3.994～8.864	<0.001
TB≥34 μmol/L	1.037	1.021～1.053	<0.001
肿瘤数量≥2个	2.821	1.663～4.785	<0.001
肿瘤TNM分期Ⅲ期	0.680	0.478～0.968	0.032
保守治疗	8.147	4.142～16.024	<0.001

表4 影响肝癌自发破裂出血患者远期生存率的多因素分析

参数	HR	95%CI	P值
肝硬化	9.167	3.849～21.834	<0.001
肝功能Child-Pugh分级C级	5.950	3.994～8.864	<0.001
TB≥34 μmol/L	1.037	1.021～1.053	<0.001
肿瘤数量≥2个	2.821	1.663～4.785	<0.001
肿瘤TNM分期Ⅲ期	0.680	0.478～0.968	0.032
保守治疗	8.147	4.142～16.024	<0.001

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Analysis of short- and long-term prognostic factors for patients with spontaneous rupture and bleeding of primary liver cancer

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Analysis of short- and long-term prognostic factors for patients with spontaneous rupture and bleeding of primary liver cancer