| Objective: This study seeks to acquire clinical case data from patients with primary liver cancer(PLC)that is complicated by pulmonary metastasis(PM)and no PM,and to utilize retrospective research methods to evaluate the risk factors and features of PLC combined with PM,thus furnishing a definitive reference for clinical diagnosis and treatment.Methods: From December 2018 to December 2022,the Department of Hepatology of our hospital chose patients with first-time confirmed PLC who had been hospitalized.According to the case data,lung metastasis was divided into PLC combined with PM group(referred to as PLC+PM)and no PM(referred to as PLC)groups,and the clinical information of the two groups of patients was collected,including: gender,age,occupation,smoking history,alcohol history,hepatitis C history,hepatitis B history,liver cirrhosis history,family history of liver disease,five tumors,related liver function indicators,coagulation function,comorbidities and TCM syndrome type.Examining the Excel database,SPSS26.0 is employed for data analysis,with the measurement data expressed as mean ± standard deviation.An independent sample t-test can be applied between two groups of normal distribution,and one-way ANOVA can be used to compare multiple groups of normal distribution and homogeneity of variance,while non-conformants can be compared through nonparametric tests.To verify whether the univariate factors are independent,a binary logistic regression model is established,and when the P<0.05 and OR>1,these univariates are considered independent risk factors for PLC combined with PM.By depicting the subject’s working characteristic curve(ROC),the prediction accuracy can be judged,and the situation of PLC combined with PM TCM symptom type and its correlation with various factors can be studied.P<0.05 indicates statistical significance.Results:1.The PLC+PM group had a greater proportion of smokers than the PLC group,and their occupational distribution was distinct from that of the PLC group,with the results being statistically significant(P<0.05).Gender,age,drinking history,and family history of liver disease were not found to be significantly different between the two groups(P>0.05).2.A comparison of clinical data between the two groups revealed that the maximum tumor diameter and tumor number,AFP,CA125,CA153,CA199,D-D,DBITI,AST,ALP,GGT,AFU,TC,TG,in the PLC+PM group were higher than those in the PLC group(P<0.05);however,no significant difference was found between CEA,PT,INR,PTA,APPT,TT,FIB,TBILI,IBILI,TP,ALB,ALT and TBA(P>0.05).3.A statistically significant difference(P<0.05)was observed between the PLC+PM combination and the PLC group,with the former having a higher proportion of pleural effusion and portal cancer thrombus.no noteworthy disparities were observed between the two assemblages of individuals with chronic viral hepatitis C,chronic viral hep-atitis B,liver cirrhosis,diabetes,hypertension,ascites,and portal hyper-tension(P>0.05).4.Risk factor analysis of PLC+PM group: The results of logistic regression analysis showed that smoking history,occupation,alpha-fetoprotein,the number of tumors,tumor diameter,and portal cancer thrombus were the main risk factors for PLC combined with lung metastasis(OR>1 and P<0.01).5.The accuracy of PLC combined with PM was found to be relatively high when the smoking history,occupation,alpha-fetoprotein,tumor diameter size,number of tumors,and the area under the curve of various indexes of portal cancer thrombus were calculated.The areas under the curve were 0.646,0.580,0.686,0.697,0.703,and 0.678.6.The two groups of data exhibited distinct distribution of TCM symptom type: 126(34.5%)of liver heat and blood stasis in the PLC group,87(23.8%)of hepatobiliary humid fever,82(22.5%)of liver depression and spleen deficiency,36(9.9%)of spleen deficiency and dampness,and 34(9.3%)of liver and kidney deficiency.The distribution of TCM symptoms in the PLC+PM group was 28 cases(35.0%)of liver depression and spleen deficiency>22 cases(27.5%)of hepatobiliary humid fever> There were 19 cases(23.8%)of liver heat and blood stasis> There were 7 cases(8.8%)of liver and kidney yin deficiency > 4 cases(5.0%)of spleen deficiency.7.No statistically significant difference was found between the two groups in terms of P values of hepatobiliary humid fever,liver heat and blood stasis,spleen deficiency and dampness,and liver and kidney yin deficiency,all of which were > 0.05.and the difference was not statistically significant,there were no statistical differences between the two groups in hepatobiliary humid fever,hepatic heat and blood stasis,spleen deficiency and dampness,and liver and kidney yin deficiency.The P value of hepatic depression and spleen deficiency in the two groups was < 0.05,a statistically significant result,and the proportion of people with liver depression and spleen deficiency in the PLC+PM group was greater than that in the PLC group.8.Correlation between medical evidence type and various factors in PLC+PM group: The age and FIB of liver and kidney yin deficiency were higher than those of hepatic depression and spleen deficiency,hepatobiliary humid fever,and liver heat and blood stasis(P<0.05),and the age of spleen deficiency and dampness was higher than that of liver heat and blood stasis(P<0.05).There were differences in the overall distribution of TBITI,DBITI and IBITI in hepatobiliary humid fever and hepatic depression and spleen deficiency and hepatic heat stasis(P<0.05).There was a difference in the overall distribution of ALT in hepatic fever and hepatobiliary humid fever(P<0.05).There were differences between TBA and hepatobiliary spleen deficiency and hepatic heat and blood stasis(P<0.05).Conclusion:1.CA125,CA153,CA199,D-D,DBITI,AST,ALP,GGT,AFU,TC,TG,combined pleural effusion may be influencing factors of primary liver cancer.2.The following were the characteristics of traditional Chinese medicine syndrome type in PLC+PM group: hepatic depression and spleen deficiency,hepatobiliary humid fever,liver heat blood stasis,liver and kidney yin deficiency,spleen deficiency and dampness.A high-risk symptom of primary liver cancer lung metastasis is a lack of hepatobiliary and spleen.hepatobiliary humid fever may be more affected by TBITI,DBITI,IBITI,compared with liver heat and blood stasis,hepatobiliary humid fever may be greatly affected by ALT,and liver and kidney yin deficiency may be affected by age and FIB.3.Smoking history,occupation,AFP,tumor diameter,number of tumors,and portal cancer thrombus were independent risk factors for PLC and lung metastasis,which could be used as predictors of PLC+PM. |
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