70 岁以上老年原发性肝癌患者临床特点

目的:探讨70岁以上高龄原发性肝癌患者临床表现、诊治方法和预后特点。方法:回顾性研究我院2000～2010年间70例原发性肝癌患者(PLC)临床资料,比较两组患者(≥70岁,高龄组;和<70岁,低龄组)的临床特点和预后。结果:≥70岁患者36例(51.4%),<70岁34例(48.6%)。与低龄组相比,高龄组心脏病(50.0%vs 17.6%)和糖尿病(41.7%vs 14.7%)显著增高(P=0.004-0.012);而乙型病毒性肝炎感染率低(50.0%vs 88.2%,P=0.016),发病时平均肿瘤直径小(3.4±2.3cm vs 5.8±4.4cm,P=0.02)。两组男性发病率、饮酒、脑血管病、首发症状和体征、肝硬化、肿瘤位置、肿瘤形态、AFP、发病时Child分级、组织学类型两组无显著差异(P>0.05)。总体(59,84.3%)以肝动脉化疗栓塞(TACE)治疗为主,平均治疗3.2±3.1次,两组接受TACE治疗患者和次数无差异。平均随访28.9月,生存分析显示两组死亡率(63.9%vs 58.8%,p=0.66)和中位生存时间(25.5月vs 20.5月,P=0.88)无显著差异。结论:≥70岁高龄PLC患者有较高的心脏病和糖尿病合并率,但多数可耐受系统性TACE治疗,从而有效延长老年患者的平均生存时间。

Clinical Features and Prognosis of Primary Liver Cancer in ElderlyPatients Over 70 Years Old

Objective: To investigate the clinical characteristics,diagnosis,treatments and prognosis of Primary liver cancer(PLC) in patients over seventy years old.Methods: A total of eligible 70 PLC patients from a tertiary hospital were indentified from 2000 to 2010.The clinical data and follow-up information of these patients were reviewed and retrieved.We compared these clinical features in patients at an advanced age more than 70 year(≥70 group) and those less than 70 year old(<70 group).Results: 36 cases(51.4%) were in≥70 group and 34(48.6%) in<70 group.Compared with younger patients,there were higher comorbid rates of cardiovascular disease(50.0% vs 17.6%) and diabetes mellitus(41.7% vs 14.7%),(P= 0.004-0.012).However,the incidence of viral hepatitis type B(50.0% vs 88.2%,P=0.016) and diameter of PLC mass at the initial diagnose(3.4±2.3cm vs 5.8±4.4cm,P=0.02) were lower.There were no significant differences between two groups regarding baseline data including male sex,alcohol abuse,cerebrovascular disease,initial symptoms and physical signs,tumor location,tumor shape,AFP level,Child-Pugh score,and histopathologic results.Totally 59 cases(84.3%) received 3.2±3.1times transarterial chemoembolization(TACE).During the mean 28.9 months follow-up,survival outcomes showed that individual cumulative mortality(63.9% vs 58.8%,P= 0.66) and median survival duration(25.5 months vs 20.5 months,P = 0.88) were similar between two groups.Conclusion: Despite a higher comorbid rate of cardiovascular disease and diabetes mellitus,the curative TACE may still be feasible and provide survival benefits for major of PLC patients of advanced age more than 70 years old.