原发性肝癌骨转移患者临床特征及预后影响因素分析

摘要

目的：探讨原发性肝癌(primary hepatic carcinoma, PHC)骨转移患者的临床特征和预后影响因素。方法对我院2004年2月—2013年5月收治的103例 PHC 骨转移患者的临床资料进行回顾性分析,总结其临床特征和生存质量,采用 Cox 回归模型分析影响患者预后的相关因素。结果本组73例为多发性骨转移,67例呈混合性骨破坏,部位分布以脊柱为主。本组生存时间0~46个月,中位生存期14.5个月,1、2、3年累积生存率依次为55.3%、29.1%、12.6%。多元 Cox 回归分析显示,伴其他部位转移(RR =2.67,95% CI 1.51~4.72)、肝内病灶未控制(RR =3.02,95% CI 1.75~5.21)、肝内多个肿瘤灶(RR =2.13,95% CI 1.32~3.44)和诊断骨转移时甲胎蛋白(AFP)偏高(RR =1.89,95% CI 1.08~3.29)为 PHC 骨转移预后的危险因素。结论 PHC 骨转移患者远期预后较差,伴其他部位转移、肝内病灶未控制、肝内多个肿瘤灶和诊断骨转移时 AFP 偏高的 PHC 骨转移患者预后风险增加。%Objective To investigate the clinical characteristics and prognosis factors of patients with bone metastasis from primary hepatic carcinoma (PHC). Methods The clinical data of 103 patients with bone metastasis from PHC in de-partment of oncology were retrospectively analyzed. The characteristics and survival quality were summarized and the prognosis factors for bone metastasis from primary hepatic carcinoma were investigated by Cox model. Results There were 73 cases with multiple bone metastases and 67 cases with a mixed type of bone destruction and the mainly metastases place was the spine bone. The survival times of PHC patients were between 0 and 46 months with a median time of 14. 5 months and survival rates since the diagnosis of bone metastases of 1 year, 2 years and 3 years were 55. 3% , 29. 1% and 12. 6% respectively. Multivariate Cox regression showed that with metastasis to other organs (RR = 2. 67, 95% CI: 1. 51 ~ 4. 72), uncontrolled liver lesions (RR = 3. 02, 95% CI: 1. 75 ~ 5. 21), multiple hepatic lesions (RR = 2. 13, 95% CI: 1. 32 ~ 3. 44) and high AFP at the diagnosis of bone metastasis (RR = 1. 89, 95% CI: 1. 08 ~ 3. 29) were prognostic risk factors. Conclusion The long-term prognosis of patients with bone metastases from PHC is poor. The patients with metastasis to other organs, or uncon-trolled liver lesions, or multiple hepatic lesions, or high AFP are more likely to have poor prognosis.