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原发性肝细胞癌自发破裂的风险因素分析

Risk factors of spontaneous rupture of hepatocellular carcinoma

摘要:

目的 探讨原发性肝细胞癌(hepatocellular carcinoma,HCC)自发破裂(spontaneous rupture,SR)的风险因素.方法 回顾性分析川北医学院附属医院2005年1月1日至2009年8月31日间收治的409例HCC的临床资料.二分类Logistic回归模型行SR的风险因素分析.KaplanMeier法计算生存时间,做Log-rank检验.结果 409例HCC中,发生SR 40例(9.8%,40/409).根据有无急腹症和(或)血流动力学不稳定划分为HCC-SR Ⅰ型和Ⅱ型,其中HCC-SR Ⅰ型19例(4.7%,19/409),SRⅡ型21例(5.1%,21/409).HCC-SR Ⅰ型1,2和3年生存率分别为26.3%(5/19),5.3%(1/19)和0%(0/19).HCC-SRⅡ型1,2和3年生存率分别为66.7%(14/21),42.9%(9/21)和19.5%(5/21),差异有统计学意义(P=0.011,0.009,0.049).多因素分析显示肝硬化程度、WBC>10×109/L和AST≥2N是HCC-SR Ⅰ型的风险因素,AFP升高和合并门静脉癌栓是HCC-SRⅡ型的风险因素.结论 HCC-SR存在两种不同的类型,风险因素并不相同.肝硬化程度,WBC>10×109/L和AST≥2N是HCC-SR Ⅰ型的风险因素,AFP升高和合并门静脉癌栓是HCC-SRⅡ型的风险因素.

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abstracts:

Objective To explore risk factors relating to occurrence of spontaneous rupture (SR)of hepatocellular carcinoma (HCC). Methods We retrospectively reviewed medical records of 409 HCC patients treated in our department from Jan. 1st 2005 to Aug. 31st 2009. Clinicopathologic factors were explored for their possible association with occurrence of SR by univariate and multivariate analysis using Logistic regression model. Results Among 409 patients, SR occurred in 40 patients (9. 8% , 40/409).Type of SR was defined according to presentation of acute abdominal emergency, especially unstable hemodynamic status. Nineteen cases (4. 7%, 19/409) were grouped as type of HCC-SR Ⅰ and 21 cases (5. 1% ,21/409) as HCC-SR Ⅱ. Patients in the two groups possessed similar hepatitis infection status,severity of background liver disease and tumoral factors except for tumoral location, while HCC-SR Ⅰ group often needed emergency treatment demonstrating elevated values of aspartate aminotransferase (AST) and WBC, decreased PLT counts and worse Child-Pugh classification. Patients in the HCC-SR Ⅱ group had more opportunities of receiving curative hepatectomy and had longer overall survival. The 1,2 and 3 year survival rates were 26. 3 % (5/19), 5. 3% ( 1/19 ) and 0% (0/19)in the HCC-SR Ⅰ group and 66. 7% ( 14/21 ),42.9% (9/21)and 19. 5% (5/21) in the HCC-SR Ⅱ group, respectively. Differences reached statistical significance( P = 0. 011,0. 009,0. 049). Multivariate analysis identified that severity of concomitant liver cirrhosis , WBC > 10 × 109/L and AST level more than twice normal (2N) as independent risk factors associating with occurrence of HCC-SR Ⅰ , while elevated values of AFP and presence of tumor thrombi in portal vein branch related to HCC-SR Ⅱ. Conclusions HCC-SR includes two different types, since different risk factors predict occurrence of each HCC-SR type.

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