Analysis Of Clinical Features Of Primary Liver Cancer And Risk Factors Of Portal Vein Tumor Thrombosis

Objective : The purpose of this study is to analyze and summarize the clinical characteristics of patients with primary liver cancer(PLC)admitted to Yan’an University Affiliated Hospital,and to improve the level of diagnosis and treatment;and to screen the risk factors of PLC patients with portal vein tumor thrombosis(PVTT),and guide the monitoring of high-risk groups and necessary interventions to provide a basis for early diagnosis and treatment of patients.Methods:The PLC patients admitted to Yan’an University Affiliated Hospital from2014.1.1 to 2018.12.31 were screened in the medical record browser,and 537 patients were identified as the research objects according to the inclusion and exclusion criteria.Collected demographic data,medical history,clinical,laboratory and imaging indicators,and analyzed the overall characteristics of the research population.Grouped by gender,age,body mass index,alpha-fetoprotein level,and clinical stage to analyzed different clinical characteristics.According to the diagnostic criteria of PVTT,the study subjects were divided into 167 cases in the PLC combined PVTT group and 370 cases in the pure PLC group.The risk factors of combined PVTT were screened through single factor analysis,and meaningful factors were included in the binary logistic regression for multivariate analysis to screen out independent risk factors.Summarized the clinical features of PLC and risk factors for PVTT.Results:1.Among the 537 patients with PLC,77.8% are males;65.2% are between 45 and64 years old;56.2% are farmers by profession;36.3% of patients in Yan’an City are in Baota District;The most common clinical symptoms are abdominal distension,fatigue,pain in the liver area/abdominal pain,anorexia,and weight loss;14.5% of patients with no clinical symptoms;80.6% due to hepatitis B virus infection;31.1% of patients with negative alpha-fetoprotein;The China liver cancer staging(CNLC)is stage IV accounts for 29.8%;The patients who received surgery,ablation,and TACE treatment accounted for 22.3%,and the patients who received supportive treatment accounted for 73.2%.2.1 By comparing the data of PLC patients in different gender groups,it is found that the proportion of male patients with hepatitis B virus infection,smoking,and alcohol consumption is higher,RBC,ALT,GGT,CRE,and UA are higher than females,and age and PLR are lower than females(P<0.05).2.2 The study population is divided into three groups: young,middle-aged,and old and compared by age.It is found that among young patients,the number of males,drinking,smoking,and nodules>3 account for a higher proportion;The ALT,GGT and AFP of young and middle-aged patients are higher;Elderly patients with a history of hypertension and diabetes account for a higher proportion,NLR and PLR are higher,CNLC stage IV is more common(P<0.017).2.3 According to BMI,the study population is divided into four groups and compared,it is found that the obese group is younger and has a higher proportion of people with a history of diabetes;The proportion of combination with PVTT,metastasis,number of nodules>3,moderate and severe ascites,CNLC stage IV patients is higher,the nodules are larger,NLR,PLR and GGT are higher,RBC,ALB and CHE are lower in low-weight(P<0.008).2.4 After dividing AFP into three groups for comparison,it is found that the AFP-negative group was older,has fewer patients with liver cirrhosis,has better liver function,and CNLC stage I was more common;AFP ≥ 400ng/ml group had larger nodules and the number of nodules>3 and those with moderate and severe ascites are relatively high,CNLC stage IV is more common,NLR,PLR,ALT,GGT,TBil,TBA and PT are higher,ALB,CHE and CRE are lower(P<0.017).2.5 Comparison of patients in different CNLC staging groups finds that stage IV patients are older and have a lower proportion of people with a history of smoking.NLR,PLR,ALT,GGT,TBil,TBA,UA and PT levels are higher,while RBC,ALB and CHE levels are lower.As the patient’s stage becomes later,the proportion of low body weight,severe ascites,and AFP≥400ng/ml gradually increases(P<0.05).3.The results of univariate analysis of patients with PLC combined with PVTT show that young people,hepatitis B virus infection,combine with liver cirrhosis,number of nodules>3,nodules diameter≥3 cm,AFP≥400 ng/ml,MELD score of 12-18 points,Child-Pugh grades B and C,PLR,GGT,TBil,TBA,UA are the risk factors for combined PVTT;RBC,ALB,and overweight are the protective factors.The results of multivariate analysis show that hepatitis B virus infection,the number of nodules>3,the diameter of nodules≥3cm,and AFP≥400ng/ml are independent risk factors for PLC combined with PVTT.Conclusion:1.Among the study population,most are male,middle-aged,farmer,with hepatitis B virus infection and CNLC stage IV.Abdominal distension,fatigue,pain in the liver area or abdominal pain are the most common symptoms.AFP negative accounts for about one-third,and support treatment is the mainstay.2.Men with hepatitis B virus infection,smoking,or drinking,who have diabetes and are of low weight,need to be closely monitored to be alert to the occurrence of liver cancer.3.With hepatitis B virus infection,number of nodules>3,nodules diameter≥3 cm,and AFP≥400 ng/ml are high risk factors for PVTT in patients with PLC.