1302例单中心观察性肝细胞癌真实世界队列的流行病学特征与预后

何雅婧; 张植明; 何伟猛; 侯金林

doi:10.3969/j.issn.1001-5256.2019.05.014

1302例单中心观察性肝细胞癌真实世界队列的流行病学特征与预后

DOI: 10.3969/j.issn.1001-5256.2019.05.014

南方医科大学南方医院感染内科暨肝病中心

基金项目:

中国肝炎防治基金会天晴肝病研究基金课题(TQGB20190270)；南方医科大学南方医院“临床研究专项”(2018CR006)；广州市健康医疗协同创新重大计划(201803040013)；

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中图分类号: R735.7
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出版历程
- 收稿日期: 2019-02-12
- 出版日期: 2019-05-20

Epidemiological characteristics and prognosis of hepatocellular carcinoma: A single-center observational real-world cohort study of 1302 cases

Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University

Research funding:

摘要

摘要: 目的探讨肝细胞性肝癌（HCC）的整体流行病学特征及临床预后。方法持续记录2011年1月1日-2017年10月31日在南方医院肝病中心确诊并住院诊治的1302例HCC患者的临床及随访资料,分析其流行病学及复发、生存特征。计数资料组间比较采用χ2检验,Kaplan-Meier计算生存率与复发率,log-rank检验比较组间差异。结果 1302例患者男:女8. 50:1,平均（52. 46±11. 51）岁。病因以HBV感染者最多,共1163例（89. 32%）,其中HBeAg阳性者:HBeAg阴性者1:3. 05; HCV 32例（2. 46%）,HBV合并HCV感染者12例（0. 92%）。1012例合并肝硬化（77. 73%）。肝功能分级中,以Child-Pugh A～B和白蛋白-胆红素（ALBI） 1～2级为主。巴塞罗那（BCLC）分期:0期76例（5. 84%）,A期474例（36. 41%）,B期236例（18. 13%）,C期504例（38. 71%）,D期12例（0. 92%）。261例（20. 05%）基线治疗即获根治,手术为主要治疗方法;其余1041...
- 乙型肝炎病毒 /
- 癌,肝细胞 /
- 预后 /
- 队列研究
Abstract: Objective To investigate the epidemiological characteristics and clinical prognosis of hepatocellular carcinoma ( HCC) . Methods 1302 HCC patients who were diagnosed and treated in Hepatology Center, Nanfang Hospital, from January 1, 2011 to October 31, 2017 were enrolled, and their clinical and follow-up data were recorded to analyze epidemiological characteristics, recurrence, and survival. The chi-square test was used for comparison of categorical variables, and the Kaplan-Meier method was used to calculate survival and recurrence rates, log-rank test was used for comparison. Results 1302 patients with a male/female ratio of 8. 50 : 1 and a mean age of52. 46 ± 11. 51 years. Of all 1302 patients, 1163 ( 89. 32%) had HBV infection, with a HBeAg-positive/HBeAg-negative ratio of 1: 3. 05; 32 ( 2. 46%) had HCV infection, and 12 ( 0. 92%) had HBV and HCV infections. Of all patients, 1012 ( 77. 73%) had liver cirrhosis. As for liver function classification, most patients are had Child-Pugh class A-B and albumin-bilirubin grade 1-2 liver disease.As for Barcelona Clinic Liver Cancer ( BCLC) stage, 76 patients ( 5. 84%) had BCLC stage 0, 474 ( 36. 41%) had stage A, 236 ( 18. 13%) had stage B, 504 ( 38. 71%) had stage C, and 12 ( 0. 92%) had stage D HCC. Of all 1302 patients, 261 ( 20. 05%) received radical treatment at baseline, and surgery was the main treatment method; among the remaining 1041 patients ( 79. 95%) , most of them received transarterial chemoembolization. The follow-up time ranged from 0. 27 to 88. 70 months, with a median follow-up time of 13. 33 months.The 5-year median overall survival time of all patients was 21. 53 ± 1. 59 months ( 95% confidence interval [CI]: 18. 411-24. 656) , and there was a significant difference in survival time between the patients with different BCLC stages ( P < 0. 001) . In the patients who received radical treatment, the 5-year median overall survival time was not obtained, and their 5-year median recurrence-free survival time was40. 90 ± 4. 81 months ( 95% CI: 31. 467-50. 333) . Conclusion HCC has the epidemiological characteristics from the aspects of demography, etiology, tumor features, and treatment and prognosis, and there are still problems such as a low rate of identification in the early stage, a low rate of radical treatment, and a short survival time. Strategies for HCC prevention and treatment require further investigation and improvement.
- carcinoma, hepatocellular /
- hepatitis B virus /
- prognosis /
- cohort studies

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参考文献(29)

[1] BRAY F, FERLAY J, SOERJOMATARAM I, et al. Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68 (6) :394-424.

[2] CHEN WQ, SUN KX, ZHENG RS, et al. Report of cancer incidence and mortality in different areas of China, 2014[J]. China Cancer, 2018, 27 (1) :1-14. (in Chinese) 陈万青, 孙可欣, 郑荣寿, 等. 2014年中国分地区恶性肿瘤发病和死亡分析[J].中国肿瘤, 2018, 27 (1) :1-14.

[3] KULIK L, EL-SERAG HB. Epidemiology and management of hepatocellular carcinoma[J]. Gastroenterology, 2019, 156 (2) :477-491.

[4] SINGAL AG, EL-SERAG HB. Hepatocellular carcinoma from epidemiology to prevention:Translating knowledge into practice[J]. Clin Gastroenterol Hepatol, 2015, 13 (12) :2140-2151.

[5] BESTE LA, LEIPERTZ SL, GREEN PK, et al. Trends in burden of cirrhosis and hepatocellular carcinoma by underlying liver disease in US veterans, 2001-2013[J]. Gastroenterology, 2015, 149 (6) :1471-1482.

[6] WANG FS, FAN JG, ZHANG Z, et al. The global burden of liver disease:The major impact of China[J]. Hepatology, 2014, 60 (6) :2099-2108.

[7] SIA D, VILLANUEVA A, FRIEDMAN SL, et al. Liver cancer cell of origin, molecular class, and effects on patient prognosis[J]. Gastroenterology, 2017, 152 (4) :745-761.

[8] LLOVET JM, ZUCMAN-ROSSI J, PIKARSKY E, et al. Hepatocellular carcinoma[J]. Nat Rev Dis Primers, 2016, 2:16018.

[9] National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology:Hepatobiliary cancers (2012) [EB/OL]. https://www. nccn. org/.

[10] Chinese Society of Liver Cancer, Chinese Anti-Cancer Association; Chinese Society of Clinical Oncology, Chinese AntiCancer Association; Liver Cancer Study Group, Chinese Society of Hepatology, Chinese Medical Association. Expert consensus on standardized diagnosis and treatment of primary liver cancer[J]. J Clin Hepatol, 2009, 25 (2) :83-92. (in Chinese) 中国抗癌协会肝癌专业委员会, 中国抗癌协会临床肿瘤学协作专业委员会, 中华医学会肝病学分会肝癌学组.原发性肝癌规范化诊治的专家共识[J].临床肝胆病杂志, 2009, 25 (2) :83-92.

[11] JOHNSON PJ, BERHANE S, KAGEBAYASHI C, et al. Assessment of liver function in patients with hepatocellular carcinoma:A new evidence-based approach-the ALBI grade[J]. J Clin Oncol, 2015, 33 (6) :550-558.

[12] FERLAY J, SOERJOMATARAM I, DIKSHIT R, et al. Cancer incidence and mortality worldwide:Sources, methods and major patterns in GLOBOCAN 2012[J]. Int J Cancer, 2015, 136 (5) :e359-e386.

[13] POK S, BARN VA, WONG HJ, et al. Testosterone regulation of cyclin E kinase:A key factor in determining gender differences in hepatocarcinogenesis[J]. J Gastroenterol Hepatol, 2016, 31 (6) :1210-1219.

[14] NAUGLER WE, SAKURAI T, KIM S, et al. Gender disparity in liver cancer due to sex differences in MyD88-dependent IL-6 production[J]. Science, 2007, 317 (5834) :121-124.

[15] BERGMANN J, MULLER M, BAUMANN N, et al. IL-6 trans-signaling is essential for the development of hepatocellular carcinoma in mice[J]. Hepatology, 2017, 65 (1) :89-103.

[16] BOSCH FX, RIBES J, DIAZ M, et al. Primary liver cancer:Worldwide incidence and trends[J]. Gastroenterology, 2004, 127 (5 Suppl 1) :S5-S16.

[17] ZHANG MY, NIU JQ. Prevalence of primary liver cancer in Eastern countries and related influencing factors[J]. J Clin Hepatol, 2018, 34 (7) :1399-1402. (in Chinese) 张明媛, 牛俊奇.东方国家原发性肝癌发病趋势及影响因素[J].临床肝胆病杂志, 2018, 34 (7) :1399-1402.

[18] FATTOVICH G, STROFFOLINI T, ZAGNI I, et al., Hepatocellular carcinoma in cirrhosis:Incidence and risk factors[J].Gastroenterology, 2004, 127 (5 Suppl 1) :S35-S50.

[19] KIM GA, LIM YS, HAN S, et al. High risk of hepatocellular carcinoma and death in patients with immune-tolerantphase chronic hepatitis B[J]. Gut, 2018, 67 (5) :945-952.

[20] LOK AS. Does antiviral therapy for hepatitis B and C prevent hepatocellular carcinoma?[J]. J Gastroenterol Hepatol, 2011, 26 (2) :221-227.

[21] FUNG J, CHEUNG KS, WONG DK, et al. Long-term outcomes and predictive scores for hepatocellular carcinoma and hepatitis B surface antigen seroclearance after hepatitis B eantigen seroclearance[J]. Hepatology, 2018, 68 (2) :462-472.

[22] CHO JY, PAIK YH, SOHN W, et al. Patients with chronic hepatitis B treated with oral antiviral therapy retain a higher risk for HCC compared with patients with inactive stage disease[J].Gut, 2014, 63 (12) :1943-1950.

[23] CHOI J, KIM GA, HAN S, et al. Longitudinal assessment of three serum biomarkers to detect very early stage hepatocellular carcinoma[J]. Hepatology, 2018.[Epub ahead of prin]

[24] LUO P, YIN P, HUA R, et al. A Large-scale, multicenter serum metabolite biomarker identification study for the early detection of hepatocellular carcinoma[J]. Hepatology, 2017.[Epub ahead of print]

[25] KOKUDO T, HASEGAWA K, MATSUYAMA Y, et al. Liver resection for hepatocellular carcinoma associated with hepatic vein invasion:A Japanese nationwide survey[J]. Hepatology, 2017, 66 (2) :510-517.

[26] NAKAHIRA S, TAKEDA Y, KATSURA Y, et al. Laparoscopic left hepatectomy with tumor thrombectomy in patients with hepatocellular carcinoma concomitant with advanced portal vein tumor thrombus[J]. Surg Endosc, 2014, 28 (12) :3505.

[27] YE JZ, WANG YY, BAI T, et al. Surgical resection for hepatocellular carcinoma with portal vein tumor thrombus in the Asia-Pacific region beyond the Barcelona clinic liver cancer treatment algorithms:A review and update[J]. Oncotarget, 2017, 8 (54) :93258-93278.

[28] TOPALIAN SL, TAUBE JM, ANDERS RA, et al. Mechanismdriven biomarkers to guide immune checkpoint blockade in cancer therapy[J]. Nat Rev Cancer, 2016, 16 (5) :275-287.

[29] EL-KHOUEIRY AB, SANGRO B, YAU T, et al. Nivolumab in patients with advanced hepatocellular carcinoma (CheckMate040) :An open-label, non-comparative, phase 1/2 dose escalation and expansion trial[J]. Lancet, 2017, 389 (10088) :2492-2502.

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