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目的探讨隐源性肝细胞癌(肝癌)的临床特点及预后。方法回顾性分析2001年1月至2012年12月在中山大学附属第三医院接受诊治的177例隐源性肝癌患者临床资料。所有患者均签署知情同意书,符合医学伦理学规定。其中男138例,女39例;年龄30~82岁,中位年龄56岁。收集患者临床特征资料,调查HBV血清学标志物分布情况。根据不同的治疗方式将患者分为手术切除组(24例)、综合治疗组(88例)和保守治疗组(65例),比较3种治疗方法对患者生存率的影响。结果 177例患者中男女比约为4∶1,年龄>60岁者占48.0%(85/177);合并肝硬化者占90.4%(160/177),合并非酒精性脂肪性肝病、糖尿病者分别占19.2%(34/177)和21.5%(38/177);抗-HBc阳性者占70.6%(125/177),AFP>400μg/L者占31.6%(56/177);肝功能Child-Pugh分级A级占62.7%(111/177);肿瘤直径≤5 cm者占35.6%(63/177),肿瘤单发者占54.2%(96/177);巴塞罗那临床肝癌(BCLC)分期A期占9.6%(17/177),B~D期占90.4%(160/177)。手术切除组患者1年生存率为92%,综合治疗组为65%,保守治疗组仅为8%。结论隐匿性HBV感染可能是隐源性肝癌的主要病因,非酒精性脂肪性肝病及糖尿病也可能对发病起重要作用。隐源性肝癌多发生在肝硬化基础之上,就诊时常常为中晚期,治疗效果及预后不佳,定期随访、早期诊断是改善预后的关键。
Objective To investigate the clinical characteristics and prognosis of cryptogenic hepatocellular carcinoma (HCC). Methods The clinical data of 177 patients with cryptogenic liver cancer admitted to the Third Affiliated Hospital of Sun Yat-sen University from January 2001 to December 2012 were retrospectively analyzed. All patients signed informed consent, in line with medical ethics rules. There were 138 males and 39 females, aged 30-82 years, with a median age of 56 years. Clinical characteristics of patients collected data to investigate the distribution of HBV serological markers. Patients were divided into surgical resection group (24 cases), comprehensive treatment group (88 cases) and conservative treatment group (65 cases) according to different treatment methods. The effects of three treatment methods on survival rate were compared. Results The ratio of male to female was about 4:1 in 177 patients, 48.0% (85/177) in patients over 60 years old, 90.4% (160/177) in patients with cirrhosis, non-alcoholic fatty liver disease and diabetes Accounting for 19.2% (34/177) and 21.5% (38/177) respectively; anti-HBc positive accounted for 70.6% (125/177), AFP> 400μg / L accounted for 31.6% (56/177); liver function Child -Pugh grade A grade accounted for 62.7% (111/177); tumor diameter ≤5 cm accounted for 35.6% (63/177), tumor alone accounted for 54.2% (96/177); Barcelona clinical liver cancer (BCLC) staging A Period accounted for 9.6% (17/177), B ~ D period accounted for 90.4% (160/177). The 1-year survival rate was 92% in the surgical resection group, 65% in the combination therapy group and only 8% in the conservative treatment group. Conclusions Occult HBV infection may be the main cause of cryptogenic liver cancer. Non-alcoholic fatty liver disease and diabetes mellitus may also play an important role in the pathogenesis. Hypertrophic liver cancer occurs on the basis of cirrhosis, often in the treatment of advanced stage, the treatment effect and poor prognosis, regular follow-up, early diagnosis is the key to improving prognosis.