Lerose R, Molinari R, Rocchi E, Manenti F, Villa E
Department of Internal Medicine, Division of Gastroenterology, University of Modena, Via del Pozzo 71, 41100, Modena, Italy.
Eur J Cancer. 2001 Jan;37(2):239-45. doi: 10.1016/s0959-8049(00)00354-3.
The aim of this study was to evaluate the prognostic factors at presentation and survival in Italian patients with hepatocellular carcinoma (HCC). Clinical and demographic data of 176 patients consecutively observed from 1993 to 1997 were evaluated by univariate and multivariate analyses. Overall median survival was 18 months. At univariate analysis, low albumin, high bilirubin, high alkaline phosphatase, high alpha-fetoprotein (AFP); high platelet count, hepatitis B surface antigen (HBsAg)-positivity, the presence of ascites, of encephalopathy, of portal vein thrombosis (PVT), male sex, no treatment, poor differentiation, untreatable tumours and incidental diagnosis were each associated with shorter survival. HBsAg-positive subjects more often presented with untreatable lesions or diffuse tumours (P=0.001 and P=0.007, respectively) and had significantly worse survival (P=0.0057). By multiple regression analysis, low albumin, high bilirubin, abnormal AFP, presence of PVT and of untreatable lesions were independent risk factors for worse survival. Thus, the most important factors influencing survival are the degree of functional impairment of the liver, the presence of hepatitis B viral (HBV) infection, the type of diagnosis and the aggressiveness of the tumour.
本研究旨在评估意大利肝细胞癌（HCC）患者就诊时的预后因素及生存率。对1993年至1997年连续观察的176例患者的临床和人口统计学数据进行单因素和多因素分析。总体中位生存期为18个月。单因素分析显示，低白蛋白、高胆红素、高碱性磷酸酶、高甲胎蛋白（AFP）；高血小板计数、乙肝表面抗原（HBsAg）阳性、腹水、肝性脑病、门静脉血栓形成（PVT）、男性、未治疗、低分化、无法治疗的肿瘤及偶然诊断均与生存期较短相关。HBsAg阳性患者更常出现无法治疗的病变或弥漫性肿瘤（分别为P=0.001和P=0.007），且生存期明显较差（P=0.0057）。多因素回归分析显示，低白蛋白、高胆红素、AFP异常、PVT及无法治疗的病变是生存期较差的独立危险因素。因此，影响生存的最重要因素是肝脏功能损害程度、乙肝病毒（HBV）感染情况、诊断类型及肿瘤的侵袭性。
