【摘要】 目的探讨中国大陆地区合并肝细胞癌(肝癌)的多原发癌患者的特征及其预后因素。方法分别以"肝癌、多原发癌"、"hepatocellular carcinoma"及"multiple primary neoplasms"为主要中英文检索词,检索1980年1月至2015年5月中国生物医学文献数据库、中国学术期刊全文数据库、Pub Med数据库以及EMBASE数据库,筛选国内学者发表的合并肝癌的多原发癌中英文文献。收集患者一般情况、肝癌临床病理学特征、诊治及其预后,生存分析采用Kaplan-Meier法和Log-rank检验,预后影响因素分析采用Cox比例风险回归模型。结果共检索92篇相关文献,270例患者纳入研究。其中男222例,女48例,男女之比为4.6∶1。首发癌患者年龄3~88岁,中位年龄55岁;继发癌年龄13~88岁,中位年龄57岁。首发癌诊断中,阳性症状占77.2%,体检占22.8%。继发癌诊断中,术前检查发现者占41.8%,阳性症状占37.7%,术中探查占11.5%,体检占4.9%,随诊占4.1%。首发癌与继发癌的确诊时间间隔中位数为2.2(0~22.0)年。肝癌患者中,有肝炎病史者占76.2%,无肝炎病史者占23.8%。肝外肿瘤患者中,罹患双癌者占94.4%,三重癌者占5.6%。同时癌和异时癌的总体生存率、肝癌特异性生存率比较差异有统计学意义(χ2=4.494,25.434;P<0.05)。肝癌同时性诊断、肝癌及肝外肿瘤非根治性治疗为影响患者总体生存率的独立危险因素(HR=0.243,1.532,1.951;P<0.05)。肝癌非根治性治疗为影响患者肝癌特异性生存率的独立危险因素(HR=2.186,P<0.05)。结论根治性治疗是影响合并肝癌的多原发癌患者生存率的重要因素,对于肝癌及肝外肿瘤均应积极采取根治性切除术。更多还原

【Abstract】 Objective To investigate the characteristics and prognostic factors of patients with multiple primary neoplasms complicated with hepatocellular carcinoma in China’s mainland. Methods Literature about multiple primary neoplasms complicated with hepatocellular carcinoma in Chinese and English published by domestic scholars was searched in the databases of Sino Med, CNKI, Pub Med and EMBASE between January 1980 and May 2015. And the main keywords were hepatocellular carcinoma and multiple primary neoplasms both in Chinese and English. General conditions, clinicopathological characteristics of hepatocellular carcinoma, diagnosis, treatment and prognosis of the patients were collected.The survival analysis was performed using Kaplan-Meier method and Log-rank test. The prognostic influence factors were analyzed using Cox’s proportional hazards regression model. Results A total of 92 published literatures were searched out, including 270 patients. Among the patients, 222 were males and 48 were females with a male-to-female ratio of 4.6∶1. The age of primary cancer patients ranged from 3 to 88 years old with a median age of 55 years old. And the age of secondary cancer ranged from 13 to 88 years old with a median age of 57 years old. For the diagnosis of primary cancer, 77.2% of the patients were identified by positive symptoms, and 22.8% by physical examination. For the diagnosis of secondary cancer, 41.8% of patients were identified by preoperative examination, 37.7% by positive symptoms, 11.5% by intraoperative exploration, 4.9% by physical examination and 4.1% by follow-up. The median interval time between the diagnosis of primary and secondary cancers was 2.2(0-22.0) years. Among the patients with hepatocellular carcinoma, 76.2% of them had a medical history of hepatitis and 23.8% had no medical history of hepatitis. Among patients with extra-hepatic carcinoma, 94.4% of them developed double carcinomas and 5.6% suffered from triple carcinomas. There were significant differences in the overall survival rate and hepatocellular carcinoma-specific survival rate between the patients with synchronous carcinoma and metachronous carcinoma(χ~2=4.494, 25.434; P<0.05). Synchronous diagnosis of hepatocellular carcinoma, non-radical treatment for hepatocellular carcinoma and extra-hepatic carcinoma were the independent risk factors for the overall survival rate(HR=0.243, 1.532, 1.951; P<0.05). Non-radical treatment for hepatocellular carcinoma was the independent risk factor for hepatocellular carcinoma-specific survival rate(HR=2.186, P<0.05). Conclusions Radical treatment is an independent factor for the survival rate in patients with multiple primary neoplasms complicated with hepatocellular carcinoma. Radical resection is recommended for patients with hepatocellular carcinoma and extra-hepatic carcinoma.更多还原