Analysis Of Prognostic Factors Of 1553 Patients With Primary Hepatic Carcinoma

Background: Primary hepatic carcinoma(PHC) is one of the most common malignant tumor in our country with poor prognosis, there have been some research before the prognostic factors analysis, but most of them have Less study cases and shorter follow-up time, then the factors associated with survival of liver cancer is uncertain.Aims: The aim of this study was to analysis the big cases of primary hepatic carcinoma patients, screen out the main factors related to the survival of liver cancer and compare the prognosis of patients with primary hepatic carcinoma in 11 years in the center as groups.Hope provide more reference for prevention、treatment and prognosis of primary hepatic carcinoma through the analysis of the prognostic factors.Methods: The 1553 patients with primary hepatic carcinoma from Hebei Medical University Hospital from January 1st 2002 to December 31 st 2012 was included. Forteen clinical or biochemical indicators were analyzed which may affect the prognosis of patients with primary hepatic carcinoma, including gender, age, HBs Ag, HBV DNA, serum AFP level, liver biochemistry index(TBIL, ALT, AST, GGT), Child-Pugh class, number of tumor nodules, tumor size, pathologic types, PVTT, BCLC stage, antiviral treatment and therapy, then got the prognostic risk factors.We got the follow-up survival time of patients through telephone. All statistical analysis were carried out using SPSS 17.0 computer software, and screen out prognostic factors. Kaplan-Meier method was used in single factor survival analysis, the Log- rank test was used in the comparison of survival rates between groups, Cox proportional survival risk model was used in multiple factors analysis. A two-tailed P<0.05 was considered statistically significant.Results: 1 Till April 28 st 2014, the survival status of the 1553 primary hepatic carcinoma patients were followed up through telephone contact, and take them all into SPSS analysis, the overall median survival time was 12.0 months. The 1-year, 2-years, 3-years, 5-years overall survival rates were 47.4%, 33.8%, 24.8% and 15.9% respectively. The patients were divided into four groups according to the year they first time in hospital, respectively for 2002-2004, 2005-2007, 2007-2005, 2011-2012, The median survival time were: 11.0 months, 8.0 months, 10.0 months and 8.0 months. The 1-year overall survival rates were 45.8%, 41.8%, 45.7%, 41.8% respectively, the 2-year overall survival rates were 32.3%, 28.7%, 31.2%, 28.7% respectively, the 3-year overall survival rates were 23.6%, 20.1%, 22.3%, 20.1% respectively, the 5-year overall survival rates were 16.0%, 11.8%, 14.1% respectively, Log- rank test suggest differences between groups was statistically significant(X2 = 17.1, P = 17.1).2 Kaplan-Meier analysis showed that: Serum AFP level(95% CI, 10.8-13.2; P < 0.001), liver biochemistry index: TBIL(95% CI, 9.7-12.3; P< 0.001), ALT(95% CI, 9.7-12.3; P< 0.001), AST(95% CI, 9.7-12.3; P< 0.001), GGT(95%CI, 10.7-13.3; P<0.001), Child-Pugh class(95%CI, 11.5-14.5; P<0.001), number of tumor nodules(95%CI,11.9-20.1; P<0.001), tumor size(95%CI, 22.0-30.0; P<0.001), pathologic types(95%CI, 29.3-42.7; P<0.001), portal vein tumor thrombosis(PVTT)(95%CI, 9.8-12.2;P<0.001), BCLC stage(95%CI, 6.7-9.3; P<0.001), antiviral treatment(95%CI, 12.0-24.0; P<0.001), therapy(95%CI, 10.8-13.2; P<0.001)were the factors affecting the prognosis of primary liver cancer survival rate(P<0.05). Gender, age, HBs Ag and HBV-DNA were not the factors affecting the prognosis of patients with HCC(P > 0.05).3 Cox proportional hazards models:portal vein tumor thrombosis(OR=5.3; 95%CI:1.1-24.5; P < 0.005), tumor size(OR=13.2; 95%CI: 1.5-113.4; P<0.005) were independent prognostic factors for survival of patients with primary hepatic carcinoma.Conclusion:1 The single center analysis showed that survival rates of primary hepatic carcinoma patients had increased in recent years, but the overall survival rate and the prognosis were poor.2 Serum AFP level, liver biochemistry index, liver biochemistry index(TBIL, ALT, AST, GGT), the Child-Pugh class, Number of tumor nodules, tumor size, pathologic types, portal vein tumor thrombosis, BCLC stage, antiviral treatment and therapy were the factors affecting the prognosis of primary liver cancer survival rate. Gender, age, HBs Ag and HBV-DNA were not the factors affecting the prognosis of patients with primary hepatic cancer.3 The portal vein tumor thrombosis and tumor size were independent risk factors affecting the prognosis of patients with primary hepatic carcinoma.