Pawarode A, Voravud N, Sriuranpong V, Kullavanijaya P, Patt Y Z
Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Am J Clin Oncol. 1998 Aug;21(4):386-91. doi: 10.1097/00000421-199808000-00014.
Primary hepatocellular carcinoma (HCC) is a common malignancy with a dismal prognosis; new modalities of treatment as alternatives to surgery have been developed for unresectable patients. The authors obtain baseline data for the natural history of HCC so that the efficacy of new treatments may be evaluated. A retrospective study of 157 untreated patients with tissue-proven or serodiagnosed HCC was conducted. Clinical characteristics including laboratory investigation, treatment received, survival from the time of diagnosis, and prognostic factors were evaluated. There were 129 men and 28 women (ratio, 4.6:1). Median age was 50.9 years (range, 14.1-85.3 years). The most common symptoms and signs were weight loss (68.2%), abdominal fullness (62.5%), abdominal pain (51.6%), hepatomegaly (73.7%), ascites (45.2%), and jaundice (40.6%). Eighteen percent had extrahepatic metastases of which the lungs were the most common site. Seventy percent were hepatitis B virus related. Overall median survival was 8.7 weeks after the time of diagnosis. Survivals by stages were: TNM II, 16.6 weeks; TNM III, 7.3 weeks; TNM IVA, 9.7 weeks; TNM IVB, 7.6 weeks; Okuda II, 10.7 weeks; and Okuda III, 7.3 weeks. Multivariate analysis revealed serum total bilirubin and albumin as independent prognostic factors of survival. Common causes of death were upper gastrointestinal hemorrhage (34.1%), cancer-related causes (cachexia, HCC rupture, metastatic disease, 31.8%), and hepatic failure (25.0%). Patients with HCC were diagnosed at late stages of their disease and the advanced nature of the tumor precluded effective therapy. Earlier tumor detection at a time when patients are better candidates for treatment may be aided by an active surveillance program of high risk groups.
原发性肝细胞癌（HCC）是一种常见的恶性肿瘤，预后不佳；针对无法切除的患者，已开发出替代手术的新治疗方式。作者获取了HCC自然史的基线数据，以便评估新治疗方法的疗效。对157例未经治疗的经组织学证实或血清学诊断为HCC的患者进行了回顾性研究。评估了临床特征，包括实验室检查、接受的治疗、诊断后的生存期以及预后因素。其中男性129例，女性28例（比例为4.6:1）。中位年龄为50.9岁（范围为14.1 - 85.3岁）。最常见的症状和体征为体重减轻（68.2%）、腹部胀满（62.5%）、腹痛（51.6%）、肝肿大（73.7%）、腹水（45.2%）和黄疸（40.6%）。18%的患者有肝外转移，其中肺部是最常见的转移部位。70%与乙型肝炎病毒相关。诊断后总体中位生存期为8.7周。各分期的生存期分别为：TNM II期，16.6周；TNM III期，7.3周；TNM IVA期，9.7周；TNM IVB期，7.6周；奥田II期，10.7周；奥田III期，7.3周。多因素分析显示血清总胆红素和白蛋白是生存的独立预后因素。常见的死亡原因是上消化道出血（34.1%）、癌症相关原因（恶病质、HCC破裂、转移性疾病，31.8%）和肝衰竭（25.0%）。HCC患者在疾病晚期被诊断出来，肿瘤的晚期性质排除了有效治疗的可能性。对高危人群实施积极的监测计划，可能有助于在患者更适合接受治疗时更早地发现肿瘤。
