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

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

Abstract

Abstract:

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

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.

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Figures/Tables 4

References 20

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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

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

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

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

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

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