【摘要】 目的在非HBV和非HCV感染肝癌(HCC)患者中探索影响肝癌患者生存的风险因素。方法选择328名自2010年1月至2012年12月在我院进行了肝切除治疗的原发性肝癌患者,其中非HBV和非HCV感染(NBNCHCC)组为69名肝癌患者,病毒性(HBV or HCV)HCC组为259名肝癌患者。收集肝癌病人的基线临床信息并随访至术后五年的生存状况。两组间术后生存期的比较使用Kaplan-Meier方法,采用多变量Cox比例风险模型评估影响NBNC-HCC肝癌预后独立的因素。结果 NBNC-HCC和病毒性HCC患者间五年总生存期的生存曲线虽并无统计学差异性(Log-rank Chi square=3.45,P=0.063),但在随访三年后,生存期已呈现差异趋势。两组间无癌生存曲线的比较显示,NBNC-HCC患者比病毒性HCC患者有更长的无癌生存期(Log-rank Chi square=15.65,P<0.001)。多变量Cox比例回归分析发现肝脏疾病状态(肝硬化和慢性肝炎患者对比肝相对正常患者),癌细胞血管浸润(阳性对比阴性患者)、病理分级(从Ⅰ到Ⅳ级)均为导致NBNC-HCC患者总生存期降低的危险因素,死亡风险分别增加0.31、0.49和0.19倍。细胞血管浸润(阳性对比阴性患者)、病理分级(从Ⅰ到Ⅳ级)可降低NBNC-HCC患者无癌生存期,风险分别增加0.43和0.17倍。结论 NBNC-HCC比病毒性HCC患者有更长的五年无癌生存期,肝癌细胞血管浸润和高级别病理分级均为导致NBNC-HCC患者总生存期和无癌生存期降低的风险因素。更多还原

【Abstract】 Objective To investigate the risk factors that had effects on survival time of patients with non-HBV and non-HCV affected hepatocellular carcinoma.Methods A total of 328 patients with primary hepatocellular carcinoma who had been performed hepatectomy in our hospital were analyzed in this study,including agroup of 69 non-HBV and non-HCV(NBNC-HCC)affected patients,and a group of 259 HBV or HCV affected patients.Baseline clinical characteristics and five years’ follow-up information on survival were collected.Kaplan-Meier curve were used to compare survival period between the above two groups.Multiple Cox proportional regression models were used to evaluated the independent risk factors that play roles on the survival time of NBNC-HCC patients.Results Although no statistical difference in five years’ total survival curve between NBNC-HCC and virus affected HCC group(Log-rank Chi square=3.45,P=0.063),different trends in survival time had been shown since the third year of follow-up.Longer cancerfree survival time was seen in NBNC-HCC than virus affected HCC patients(Log-rank Chi square=15.65,P<0.001).Liver diseases(cirrhosis and chronic hepatitis vs.normal),cancer cells infiltrated vessels(positive vs.negative),pathological degree(from I to IV)were risk factors of total survival time of NBNC-HCC patients,and they were associated with 1.31-fold,1.49-fold and 1.19-fold increased risk of death.In addition,cancer cells infiltrated vessels and pathological degree were also associated with 1.43-fold and 1.17-fold decreased cancer-free survival time.ConclusionLonger 5 years’ cancer-free survival time was found among NBNC-HCC patients than virus affected HCC patients.Cancer cells infiltrated vessels and pathological degree were risk factors of decreased total and cancer-free survival time among NBNC-HCC patients.更多还原