Analysis Of Clinicopathological Features And Prognosis Of Primary Liver Cancer Metastasis

Objectives :1.To explore and analyze the clinical characteristics and influencing factors of primary liver cancer(PLC)metastasis,to find clinical indicators that can predict metastasis and prognosis and to evaluate their diagnostic efficacy.2.To explore and analyze the expression of ISG15 in PLC pathological tissues and its correlation with PLC metastasis and prognosis.3.To explore and analyze the correlation between the expression of ISG15 in PLC pathological tissues and various clinical indicators.Methods:According to the inclusion criteria and exclusion criteria,a retrospective study was conducted on patients with primary liver cancer who met the inclusion criteria admitted to our research center from January 2017 to December2021.The data collected included general data,clinical manifestations,blood test data,pathological indicators and prognostic survival indicators,and a database of patients with primary liver cancer was established.Statistical analysis was performed using SPSS 26.0 and Graph Pad Prism 9.0.(1)Correlation analysis : Chi-square test or Fisher ’s exact probability method was used to analyze the correlation between primary liver cancer metastasis and clinical indicators;mann-Whitney U test was used to analyze the correlation between continuous variables and metastasis of primary liver cancer.(2)Predicting the diagnostic efficacy of liver cancer metastasis :The receiver operating curve(ROC curve)was used to analyze the diagnostic efficacy of each clinical index in predicting the metastasis of primary liver cancer.(3)Survival analysis : Kaplan-Meier method was used to draw the survival curve.Cox proportional hazards regression model was used for multivariate analysis of statistically significant variables in univariate analysis.P < 0.05 was considered statistically significant.Results:1.A total of 324 patients with primary liver cancer were included in the study,with a male to female ratio of 5.11 : 1;the average age was 52.22 ± 10.47 years.There were 188 drinkers(58.02 %);there were 185 smokers(57.10 %).There were 266 cases(82.10 %)of hepatitis B infection;98 cases(30.24 %)KPS< 90 points,226 cases(69.75 %)KPS ≥ 90 points;t NM staging was mainly stage III and IV in 230 cases(70.98 %);270 cases(84.38 %)BMI < 25,50 cases(15.62 %)BMI ≥ 25;217 patients(66.97 %)had gastrointestinal symptoms for the first time.2.Of the 324 patients with primary liver cancer,227(70.06 %)had metastasis and 97(29.94 %)had no metastasis.There were significant differences in white blood cell count,platelet count,monocyte count,neutrophil count,neutrophil / white blood cell ratio,neutrophil / lymphocyte ratio,PCT,HDL,AST,total bilirubin,FIB,AFP and hepatitis B infection between metastasis group and non-metastasis group(all P < 0.05).Logistic multivariate regression analysis showed that hepatitis B infection,platelet count,NLR and total bilirubin were independent influencing factors of metastasis of primary liver cancer,all P < 0.05.3.ROC curve analysis was used to evaluate the diagnostic efficacy of clinical indicators for primary liver cancer metastasis.The three indicators with the best diagnostic value(that is,the area under the AUC curve is the largest),including hepatitis B infection(AUC = 0.711),white blood cell count(AUC = 0.620),and AFP level(AUC = 0.616),were combined in pairs,and then the three indicators were combined to compare the area of the ROC curve.The results showed that the area under the curve of the combination of three indicators was larger than that of the combination of two indicators,while the area under the curve of the combination of two indicators was larger than that of a single indicator,which fully confirmed that the combination of multiple indicators could improve the diagnostic efficacy of primary liver cancer metastasis.4.The expression of interferon-stimulated gene 15(ISG15)was detected in 59 patients with primary liver cancer.The difference of ISG15 level between metastasis group and non-metastasis group was statistically significant(P < 0.05).The expression of ISG15 was correlated with clinical stage,tumor size,tumor number,ALT,TG and IL-6(P < 0.05).The OS and PFS of ISG15 high expression group were shorter and the prognosis was worse than that of ISG5 low expression group,and the difference was statistically significant(P < 0.05).5.The median OS was 44 months in the non-metastatic group of primary liver cancer and 19 months in the metastatic group of primary liver cancer.The difference was statistically significant(P < 0.0001).The median PFS of the primary liver cancer metastasis group was 7 months,and the median PFS of the non-metastasis group was 28 months,the difference was statistically significant,P < 0.001.The number of tumors,AFP level and hepatitis B infection were statistically significant,which were independent influencing factors of OS in patients with primary liver cancer metastasis,all P < 0.05.Tumor size,hepatitis B infection,AFP level and liver damage were statistically significant,which were independent influencing factors of PFS in patients with primary liver cancer metastasis,all P < 0.05.Conclusions:1.The survival and prognosis of patients with primary liver cancer are highly heterogeneous.There are many factors affecting the metastasis and prognosis of primary liver cancer.Hepatitis B virus infection,tumor number,tumor size,AFP level,liver damage,white blood cell count and other inflammatory indicators are independent risk factors affecting the prognosis of primary liver cancer.2.The combination of hepatitis B infection + AFP + white blood cell count has the best diagnostic efficacy in predicting liver cancer metastasis.The predictive efficacy of a single indicator for primary liver cancer metastasis is limited.Reasonable combination of multiple indicators can significantly improve the diagnostic efficacy of primary liver cancer metastasis.3.ISG15 is highly expressed in primary liver cancer.The high expression group of ISG15 in liver cancer patients has shorter OS,PFS and worse prognosis than the low expression group.It has great clinical application value for the metastasis and prognosis prediction of liver cancer,and is an effective marker for the prognosis prediction of liver cancer.4.The level of ISG15 in primary liver cancer is closely related to the level of cellular inflammatory factor IL-6,indicating that inflammatory factors have potential value for prognosis prediction.