Stuart K E, Anand A J, Jenkins R L
Boston Center for Liver Cancer, Deaconess Hospital, Boston, Massachusetts, USA.
Cancer. 1996 Jun 1;77(11):2217-22. doi: 10.1002/(SICI)1097-0142(19960601)77:11<2217::AID-CNCR6>3.0.CO;2-M.
The purpose of this study was to investigate prognostic factors at presentation and the survival of North American patients with hepatocellular carcinoma (HCC).
A retrospective analysis of medical records was performed for 314 patients identified through the Tumor Registry as having been evaluated for hepatocellular carcinoma at the Deaconess Hospital, Boston, Massachusetts, from 1986 through 1995. Clinical characteristics were noted, including age, sex, TNM staging, serum biochemistries, serum alpha-fetoprotein (AFP), patency of portal vasculature, cirrhosis, history of alcohol abuse, hepatitis-B or C positivity, hemochromatosis, treatment received, and ultimate survival from the date of diagnosis.
Overall median survival was 10 months. The presence of cirrhosis, a history of alcohol abuse, low albumin, high bilirubin, abnormal AFP, and portal vein obstruction (PVO) were each associated with significantly shorter survival, as was advanced stage. Only albumin, AFP, and PVO were independent risk factors by multiple regression analysis. Patients undergoing surgery had the longest median survival (45 months), followed by those receiving chemoembolization (14 months). Those patients who were untreated or received systemic chemotherapy alone had significantly shorter survivals (2-4 months).
Despite the difference in the underlying etiology of HCC in this population compared with Asian patients, poor prognostic indicators are similar. In this large series of patients at a single Northeastern hospital, analysis of presenting clinical characteristics was found to offer useful prognostic information.
本研究旨在调查北美肝细胞癌（HCC）患者就诊时的预后因素及生存率。
对1986年至1995年在马萨诸塞州波士顿迪肯尼斯医院通过肿瘤登记处确定为已接受肝细胞癌评估的314例患者的病历进行回顾性分析。记录临床特征，包括年龄、性别、TNM分期、血清生化指标、血清甲胎蛋白（AFP）、门静脉血管通畅情况、肝硬化、酗酒史、乙肝或丙肝阳性、血色素沉着症、接受的治疗以及自诊断之日起的最终生存率。
总体中位生存期为10个月。肝硬化、酗酒史、低白蛋白、高胆红素、AFP异常和门静脉阻塞（PVO）均与生存期显著缩短相关，晚期也是如此。通过多元回归分析，只有白蛋白、AFP和PVO是独立危险因素。接受手术的患者中位生存期最长（45个月），其次是接受化疗栓塞的患者（14个月）。未接受治疗或仅接受全身化疗的患者生存期明显较短（2 - 4个月）。
尽管该人群中HCC的潜在病因与亚洲患者不同，但不良预后指标相似。在这家位于东北部的单一医院的这一大系列患者中，发现对就诊时临床特征的分析可提供有用的预后信息。
