17例老年原发性肝癌合并下腔静脉-右心房癌栓患者的临床特点及预后分析

Analysis of clinical characteristics and prognosis of 17 elderly patients with primary liver cancer complicated with inferior vena cava-right atrial cancer thrombus

中文关键词: 老年, 原发性肝癌, 下腔静脉癌栓, 右心房癌栓, 临床表现, 预后

英文关键词: elderly  primary liver cancer  inferior vena cava tumor thrombosis  right atrial tumor thrombosis  clinical manifestation  prognosis

中文摘要:

      目的 总结原发性肝癌(PLC)合并下腔静脉(IVC)及右心房(RA)癌栓患者的临床资料(年龄、性别、实验室检查等)、治疗方法及预后.方法 采用统计描述研究方法,收集首都医科大学附属北京地坛医院诊治的17例原发性肝癌合并IVC-RA癌栓患者的临床资料,总结分析其实验室检查、治疗方法及预后.结果 17例患者中男性12例,女性5例,平均年龄(76.8±15.2)岁,首次诊断PLC的平均年龄(76.1±15.7)岁;诊断原发性肝癌至累及IVC-RA的中位生存时间为5(1～40)个月.17例均为肝硬化患者,Child Pugh分级A级7例,B级6例,C级4例.14例患者的肿瘤为多发,肿瘤最大直径为(72.35±35.47)mm,10例患者的甲胎蛋白(AFP)＞400 ng/mL.巴塞罗那(BCLC)分期C期15例、D期2例.女性患者的谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)、国际标准化比值(INR)、谷草转氨酶与血小板比率指数(APRI)高于男性(P＜0.05).男性患者的凝血酶原时间(PT)低于女性(P＜0.05),凝血酶原活动度(PTA)高于女性(P＜0.05).6例患者接受保守治疗,余患者接受单独或联合肝动脉化疗栓塞术、消融、靶向、免疫治疗.患者的中位生存期为5(1～40)个月.Kaplan-Meier单因素和Cox回归多因素分析显示,年龄是PLC患者预后的保护因素,仅接受保守治疗和ALT是患者预后的独立危险因素(P=0.01).结论 PLC合并IVC-RA癌栓患者多发生在肝癌晚期,肿瘤以多发常见,AFP水平大多增高,ALT越高生存期越短,肝动脉化疗栓塞术(TACE)、消融、靶向、免疫等可延长患者的生存时间.

英文摘要:

      Objective To summarize the clinical data(age,gender,laboratory tests,etc.),treatment methods,and prognosis of patients with primary liver cancer(PLC)complicated with inferior vena cava(IVC)-right atrial(RA)tumor thrombosis.Methods The method of statistical description was adopted.The clinical data of 17 patients with PLC complicated with IVC-RA tumor thrombosis treated in Beijing Ditan Hospital Affiliated to Capital Medical University were collected,and their laboratory examination,treatment and prognosis were summarized and analyzed.Results Among the 17 patients,there were 12 males and 5 females,with an average age of(76.8±15.2)years.The average age at initial diagnosis of PLC was(76.1±15.7)years.The median survival time from diagnosis of PLC to involvement of IVC-RA was 5(1-40)months.All 17 patients had cirrhosis,with Child-Pugh class A in 7 cases,class B in 6 ones,and class C in 4 ones.The tumors were multi-ple in 14 patients,with a largest tumor diameter of(72.35±35.47)mm.AFP level＞400 ng/ml in 10 patients.Barcelona Clinic Liver Cancer(BCLC)stage C in 15 cases and stage D in 2 ones.The females had higher levels of alanine aminotrans-ferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),direct bilirubin(DBIL),international normalized ratio(INR),and aspartate aminotransferase-to-platelet ratio index(APRI)than the males(P＜0.05).The males had shorter prothrombin time(PT)than the females(P＜0.05)and higher prothrombin activity(PTA)(P＜0.05).Six patients received only conservative treatment,while the other patients received single or combined hepatic arterial chemoembolization,ablation,targeted therapy,and immunotherapy.The median survival time of the patients was 5(1～40)months.Kaplan-Meier univari-ate and Cox regression multivariate analysis showed that age was a protective factor for the prognosis of PLC patients,while conservative treatment alone and ALT were independent risk factors for the prognosis of patients.Conclusion IVC-RA tumor thrombosis mostly occurs in patients with advanced stage of PLC.Multiple tumors are common,AFP level is mostly higher,and the higher the ALT,the shorter the survival period.The treatments such as arterial chemoembolization,ablation,targeted therapy and immunotherapy can prolong the survival time of patients.