Luo Jiing-Chyuan, Hwang Shinn-Jang, Wu Jaw-Ching, Lai Chiung-Ru, Li Chung-Pin, Chang Full-Young, Chiang Jen-Huei, Lui Wing-Yiu, Chu Chen-Wei, Lee Shou-Dong
Division of Gastroenterology, Department of Medicine, Veterans General Hospital-Taipei, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Hepatogastroenterology. 2002 Sep-Oct;49(47):1315-9.
BACKGROUND/AIMS: Hepatocellular carcinoma patients with paraneoplastic syndromes usually have a larger tumor volume and a higher serum alpha-fetoprotein. Whether the presence of paraneoplastic syndromes, such as hypercholesterolemia, hypoglycemia, hypercalcemia, and erythrocytosis in hepatocellular carcinoma patients is a significant prognostic factor in patients' survival is of clinical interest.
We evaluated the occurrence of paraneoplastic syndromes in 903 hepatocellular carcinoma patients; 179 (20%) patients developed paraneoplastic syndromes either upon diagnosis or during follow-up, 179 age-sex-tumor volume-matched hepatocellular carcinoma patients without paraneoplastic syndromes were selected as controls. Serum liver biochemistry, alpha-fetoprotein, clinical Child-Pugh's score, tumor image studies, histological features, accessibility to treatment, and survival were recorded and compared between patients with and without paraneoplastic syndromes. Prognostic factors in patients' survival were analyzed. The clinical course and survival of hepatocellular carcinoma patients with different paraneoplastic syndromes were also compared.
Multivariate Cox regression analysis revealed Child-Pugh's grade C, ineligibility for active treatment, serum alpha-fetoprotein > 10,000 ng/mL, main portal vein tumor thrombosis, and the presence of paraneoplastic syndromes were all independent unfavorable prognostic factors for survival. The median survival from the occurrence of paraneoplastic manifestation to death was only 36 days. Patients with different paraneoplastic syndromes had similar clinical characteristics in Child-Pugh's score, serum alpha-fetoprotein level, tumor volume, prevalence of main portal vein tumor thrombosis, and accessibility for active treatment upon diagnosis. However, erythrocytosis and hypercholesterolemia usually developed earlier in the clinical course, whilst hypoglycemia and hypercalcemia were usually terminal events. Hepatocellular carcinoma patients with erythrocytosis tended to have a longer survival than patients with other paraneoplastic syndromes.
The presence of paraneoplastic syndromes in hepatocellular carcinoma patients is an unfavorable prognostic factor, excluding the occurrence of erythrocytosis.
背景/目的：伴有副肿瘤综合征的肝细胞癌患者通常肿瘤体积更大，血清甲胎蛋白水平更高。肝细胞癌患者中副肿瘤综合征的存在，如高胆固醇血症、低血糖症、高钙血症和红细胞增多症，是否是患者生存的重要预后因素具有临床研究意义。
我们评估了903例肝细胞癌患者中副肿瘤综合征的发生情况；179例（20%）患者在诊断时或随访期间出现了副肿瘤综合征，选取179例年龄、性别、肿瘤体积匹配但无副肿瘤综合征的肝细胞癌患者作为对照。记录并比较了有和无副肿瘤综合征患者的血清肝生化指标、甲胎蛋白、临床Child-Pugh评分、肿瘤影像学检查、组织学特征、治疗可及性和生存率。分析了患者生存的预后因素。还比较了不同副肿瘤综合征的肝细胞癌患者的临床病程和生存率。
多因素Cox回归分析显示，Child-Pugh C级、无法进行积极治疗、血清甲胎蛋白>10,000 ng/mL、主要门静脉肿瘤血栓形成以及副肿瘤综合征的存在均为生存的独立不良预后因素。从副肿瘤表现出现到死亡的中位生存期仅为36天。不同副肿瘤综合征的患者在Child-Pugh评分、血清甲胎蛋白水平、肿瘤体积、主要门静脉肿瘤血栓形成的发生率以及诊断时进行积极治疗的可及性方面具有相似的临床特征。然而，红细胞增多症和高胆固醇血症通常在临床病程中出现较早，而低血糖症和高钙血症通常是终末期事件。伴有红细胞增多症的肝细胞癌患者的生存期往往比其他副肿瘤综合征患者更长。
肝细胞癌患者中副肿瘤综合征的存在是一个不良预后因素，但红细胞增多症除外。
