摘要
目的:探讨乙肝病毒及丙肝病毒感染对肝细胞癌的临床病理特征及预后的影响。方法:收集1995—2000年在复旦大学肝癌研究所行手术切除的355例肝细胞癌患者临床病理资料及术后随访资料。其中乙肝相关肝细胞癌163例(HBV组),丙肝相关肝细胞癌73例(HCV组),119例非病毒相关肝细胞癌作为对照组(NBNC组),分析乙型肝炎病毒及丙型肝炎病毒对肝细胞癌的临床病理特征及预后的影响。结果:临床病理特征:乙肝相关肝细胞癌患者年龄轻,男性患者比例高,甲胎蛋白(AFP)均值高;丙肝相关肝细胞癌患者年龄最大,术前丙氨酸氨基转移酶(ALT)升高伴白蛋白降低者比例高,体检发现的小肝癌居多,肿瘤分期相对较早;NBNC组患者由于无肝病背景,往往缺乏定期体检,多因出现临床症状就诊,故发现时以大肝癌为主,合并血管侵犯,肿瘤突破包膜者比例高。术后生存情况:HBV-HCC组患者中位生存期为15个月,1-,3-,5～7-年生存率分别为:71.0%,34.0%,30.7%和11.53%;HCV-HCC组中位生存期为19个月,1-,3-,5～7-年生存率分别为90.3%,68.2%,41.9%和31.41%。提示丙肝病毒相关肝细胞癌总体预后好于乙肝病毒相关肝细胞癌(χ2=10.92,P<0.001)。多因素分析提示病毒感染类型是肝细胞癌预后的独立影响因素。相对于无病毒感染肝细胞癌患者而言,乙肝相关肝细胞癌术后死亡的风险是前者的1.5倍(P=0.03),而丙肝相关肝细胞癌术后死亡的风险是其0.85(P=0.58)。结论:乙肝病毒与丙肝病毒相关肝细胞癌的临床病理特征及预后有显著差异。丙肝相关肝细胞癌总体预后好于乙肝相关肝细胞癌。
Objective：To investigate the role of hepatitis B virus （HBV） and hepatitis C virus （HCV） in clinicopathological features and prognosis of patients with hepatocellular carcinoma （HCC）. Methods：A retrospective analysis of clinicopathological data of 355 patients with hepatocellular carcinoma who received hepatic resection in our hospital from 1995 to 2000. There were 163 HBV-related HCC patients included into HBV group and 73 HCV-related HCC patients included into HCV group,other 119 non-HBV and non-HCV related HCC patients were also included as control group（NBNC group）. The impact of hepatic virus on clinicopathological features and prognosis of hepatocellular carcinoma were analyzed. Results：HBV-HCC patients was featured by young age,high male/female ratio and high （AFP） level. HCV-HCC patients were associated with old age,low serum albumin level,high serum ALT level,and early-stage tumor. NBNC HCC were characterized by large tumor size,high incidence of vascular invasion and incomplete capsule since fewer NBNC-HCC patients received regular follow-up for liver diseases and hepatic tumors might be detected only after symptoms occurred. Median survival time for HBV-HCC and HCV-HCC were fifteen months and nineteen months.1-,3-,5-7-overall survival rates were 71.0%,34.0%,30.7%,11.53% for HBV-HCC respectively and 90.3%,68.2%,41.9%,31.41% respectively for HCV-HCC,respectively. The result suggested HCV-HCC patients had a longer survival time and better outcome than HBV-related patients（χ2=10.92,P0.001）. Multivariate regression analysis showed the type of hepatic virus was a dependent of Influential factors of prognosis. The postoperative death risk of HCC patients with hepatitis B virus was 1.5 times higher than that of the HCC patients without hepatitis virus infection（P=0.03）,while the death risk of HCC patients with hepatitis C virus was 0.85 times lower than that of NBNC patients（P=0.58）. Conclusions：Significant difference existed in clinicopathlogical features and surgical outcome between HCC patients with hepatitis B virus and hepatitis C virus infections. HCV-related HCC patients can obtain a better surgical outcome compared to those with HBV-related hepatocellular carcinoma.
出处
《中国临床医学》
2010年第2期195-198,共4页
Chinese Journal of Clinical Medicine
关键词
肝细胞癌
乙型肝炎病毒
丙型肝炎病毒
预后
Hepatocellular carcinoma
Hepatitis B virus
Hepatitis C virus
Prognosis
