Clinical features of patients with Barcelona Clinic Liver Cancer stage C primary liver cancer and related prognostic factors: An analysis of 140 cases

Objective To investigate the clinical features of patients with Barcelona Clinic Liver Cancer ( BCLC) stage C primary liver cancer ( PLC) and related prognostic factors. Methods A retrospective analysis was performed for the clinical data of 140 patients with BCLC stage C PLC who were admitted to Beijing Ditan Hospital, Capital Medical University, from October 2008 to December 2015. The Kaplan-Meier method was used for survival analysis, and the log-rank test was used for univariate analysis. The multivariate Cox proportional hazards model was used to analyze prognostic factors according to forward stepwise regression based on maximum likelihood estimation. Results Most of the 140 patients were male, and the male/female ratio was 6∶ 1. The three most common initial symptoms of PLC were abdominal pain or liver area pain, weakness, and abdominal distension. The median survival time was 6 months, and the median follow-up time was 10 months ( 1-80 months) . The 1-year survival rate of these patients was 22. 14%. The univariate analysis showed that Child-Pugh class, the type of portal vein tumor thrombus, tumor number, tumor morphology, tumor diameter, aspartate aminotransferase/alanine aminotransferase ( AST/ALT) ratio, and use or non-use of transcatheter arterial chemoembolization ( TACE) were associated with prognosis ( χ2= 6. 215, 19. 609, 8. 849, 11. 122, 11. 571, 7. 438, 30. 511, and 10. 690, all P < 0. 05) . The multivariate analysis showed that Child-Pugh class ( odds ratio [OR]= 1. 524, 95% confidence interval [CI]: 1. 011-2. 297, P = 0. 044) , tumor diameter ( OR = 1. 803, 95%CI: 1. 097-2. 964, P = 0. 020) , and AST/ALT ratio ( OR = 1. 769, 95% CI: 1. 301-2. 406, P < 0. 001) were independent risk factors for the prognosis of advanced PLC, while the use of TACE was a protective factor ( OR = 0. 598, 95% CI: 0. 363-0. 985, P = 0. 043) .Conclusion Advanced PLC has poor prognosis and short median survival time. A more accurate survival benefit analysis should be performed based on adverse prognostic factors to guide the selection of therapeutic paradigms in clinical practice. Increased AST/ALT ratio should also be taken seriously.