本文關(guān)鍵詞： 肝細(xì)胞癌 伴癌綜合征 肝切除術(shù) 預(yù)后　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討對于能手術(shù)切除的肝細(xì)胞癌(Hepatocellular carcinoma,HCC)患者,在基線資料保持一致的條件下,伴癌綜合征(paraneoplastic syndromes,PNS)與HCC患者預(yù)后的關(guān)系。方法:來自廣西醫(yī)科大學(xué)附屬腫瘤醫(yī)院的1446名HCC病人,其中合并伴癌綜合征的患者271名,應(yīng)用傾向匹配得分法消除混雜因素后得到266對患者。根據(jù)資料類型采用相應(yīng)的統(tǒng)計方法,對符合正態(tài)或近似正態(tài)分布的資料用?x±s描述,非正態(tài)分布的資料用M(Q1-Q3),兩組間均數(shù)比較用t檢驗(yàn),分類變量的比較用χ2檢驗(yàn),生存率分析用Kaplan-Meier法估計,兩組間差異用log-rank檢驗(yàn)比較,獨(dú)立預(yù)后因素的分析用COX回歸分析。結(jié)果:在匹配前,1446名病人中有271名病人(18.7%)出現(xiàn)PNS。HCC合并PNS患者具有年齡更小、腫瘤直徑更大、甲胎蛋白水平(AFP)更高等特點(diǎn)。在累積生存率的比較中,匹配前,PNS組患者的中位生存時間為51±8.3月,較非PNS組的64±8.1月的中位生存時間明顯縮短(P=0.0064)。匹配后,PNS組患者的中位生存時間為42.0±7.3月,較非PNS組患者21.0±2.0月的中位生存時間明顯延長(P0.001)。對各種PNS的臨床表現(xiàn)分組分析,匹配前,低血糖血癥患者的累積生存時間較非伴癌綜合征患者縮短(27.0月VS 64.0月,P0.001),紅細(xì)胞增多癥、高血小板血癥的累積生存時間與非伴癌綜合征患者相比并沒有統(tǒng)計學(xué)意義。匹配后,低血糖血癥患者的累積生存時間與非伴癌綜合征患者累積生存時間的比較沒有統(tǒng)計學(xué)意義(27.0月VS 20.0月,P=0.1827),紅細(xì)胞增多癥患者的累積生存時間明顯較非伴癌綜合征患者的累積生存時間長(70.0月VS 21.0月,P=0.0008)。圍手術(shù)期紅細(xì)胞增高癥的輸血率(10.3%)明顯低于非PNS組患者的輸血率(26.8%)。單因素分析結(jié)果顯示PNS、門靜脈癌栓、腫瘤直徑≥10cm、BCLC-C期、紅細(xì)胞增多癥為影響HCC患者術(shù)后累積生存率的高危因素。COX多因素分析顯示:BCLC-C期腫瘤直徑10cm是影響HCC患者總生存時間的獨(dú)立危險因素,而PNS紅細(xì)胞增多癥獨(dú)立保護(hù)性因素。結(jié)論:對于能手術(shù)切除的HCC患者,在腫瘤負(fù)荷相近的條件下,合并PNS患者較非PNS的患者預(yù)后更好,因此對于合并PNS的患者更應(yīng)積極手術(shù)切除。
[Abstract]:Objective: to investigate the relationship between paraneoplastic syndromes (PNSs) and prognosis of patients with HCC under the condition that the baseline data of HCC patients with resectable hepatocellular carcinoma (HCC) were consistent. Methods: 1 446 HCC patients from the Cancer Hospital affiliated to Guangxi Medical University were enrolled in this study. Among the 271 patients with cancer syndrome, 266 pairs of patients were obtained by using the tendency matching score method to eliminate the confounding factors. According to the data type, the corresponding statistical method was used for the data that accord with normal distribution or approximate normal distribution. X 鹵s was used to describe the data of non-normal distribution, t test was used to compare the mean of the two groups, 蠂 2 test was used to compare the classification variables, Kaplan-Meier method was used to estimate the survival rate, and log-rank test was used to compare the differences between the two groups. COX regression analysis was used to analyze the independent prognostic factors. Results: 271 of 1446 patients with PNS.HCC and PNS had younger age and larger tumor diameter. In the comparison of cumulative survival rate, the median survival time of PNS group was 51 鹵8.3 months. The median survival time of PNS group was significantly shorter than that of non-PNS group (64 鹵8.1 months). The median survival time of PNS group was 42.0 鹵7.3 months, which was significantly longer than that of non-#en1# group (21.0 鹵2.0 months). The cumulative survival time of patients with hypoglycemia was shorter than that of patients without cancer syndrome (27.0 months vs 64.0 months, P 0.001). The cumulative survival time of patients with polycythemia and hyperplatinemia was not significantly different from that of patients without cancer syndrome. There was no significant difference in cumulative survival time between patients with hypoglycemia and patients without cancer syndrome (27.0 vs 20.0month, P < 0.1827). The cumulative survival time of patients with polycythemia was significantly higher than that of patients without cancer syndrome. The cumulative survival time of the patients (70. 0 months vs 21. 0 months P0. 0008%) was significantly lower than that of non-PNS patients (10. 3%). The results of univariate analysis showed that PNS, portal vein tumor thrombus, and portal vein tumor thrombus were significantly lower than those in non-PNS group. Tumor diameter 鈮，

本文編號：1545396