【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χ~2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例(79. 95%)中,TACE为主要治疗方法。随访时间0. 27～88. 70个月,中位随访时间为13. 33个月。所有患者的5年中位生存时间为(21. 53±1. 59)个月,95%可信区间(95%CI):18. 411～24. 656,不同BCLC分期间的生存差异明显(P <0. 001)。在根治患者中,5年中位生存时间未获得,5年中位无复发生存时间为(40. 90±4. 81)个月,95%CI:31. 467～50. 333。结论 HCC在人口学、病原学、瘤体特征以及治疗和预后均存在其流行病学特点,仍存在早期发现率低、根治率低、生存时间短等问题,整体防治工作依然任重而道远。更多还原

【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.更多还原