肝细胞癌合并门静脉癌栓患者生存预后因素的单中心回顾性研究

Prognostic factors for survival in hepatocellular carcinoma with portal vein tumor thrombus: a single-center retrospective study

摘要:

背景与目的 肝癌合并门静脉癌栓（PVTT）患者预后极差，明确其生存预后相关因素对临床决策具有重要意义。本研究基于真实世界数据，探讨肝癌合并PVTT患者的生存预后影响因素。方法 回顾性收集2019年1月—2021年12月南昌大学江西医学院第一附属医院收治的195例肝癌合并PVTT患者临床资料，随访至2022年12月31日。采用Kaplan-Meier法进行生存分析，Log-rank检验进行单因素分析，Cox比例风险模型进行多因素分析，筛选独立预后因素。结果 195例患者中，随访期内死亡162例（83.08%），中位生存时间为114（102~126）d；30、90、180 d及1、2、3年生存率分别为82.56%、56.41%、38.97%、26.67%、18.46%和16.92%。单因素分析显示，年龄、体力状况（PS）评分、白蛋白、总胆红素（TBIL）及淋巴细胞计数与预后相关（均P<0.05）。多因素分析显示，PS评分>2、淋巴细胞计数<1.7×10?/L及TBIL>26 μmol/L为独立不良预后因素（均P<0.05）。结论 肝癌合并PVTT患者总体预后较差。PS评分升高、淋巴细胞减少及胆红素升高是影响生存的独立危险因素，可作为临床风险分层及个体化治疗的重要参考指标。

Abstract:

Background and Aims Hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) is associated with extremely poor prognosis. Identification of prognostic factors is essential for clinical decision-making. This study aimed to investigate survival-related prognostic factors in HCC patients with PVTT based on real-world data.Methods A total of 195 patients with HCC and PVTT admitted to the First Affiliated Hospital of Nanchang University between January 2019 and December 2021 were retrospectively enrolled and followed up until December 2022. Survival analysis was performed using the Kaplan-Meier method. Univariate analysis was conducted using the Log-rank test, and multivariate analysis was performed using the Cox proportional hazards model.Results During follow-up, 162 patients (83.08%) died. The median survival time was 114 (102-126) d. The 30-, 90-, 180-d, and 1-, 2-, and 3-year survival rates were 82.56%, 56.41%, 38.97%, 26.67%, 18.46%, and 16.92%, respectively. Univariate analysis identified age, performance status (PS), albumin, total bilirubin (TBIL), and lymphocyte count as significant prognostic factors (all P<0.05). Multivariate analysis revealed that PS>2, lymphocyte count <1.7×10⁹/L, and TBIL>26 μmol/L were independent predictors of poor prognosis (all P<0.05).Conclusion Patients with HCC and PVTT have poor overall survival. Elevated PS score, lymphopenia, and increased bilirubin levels are independent adverse prognostic factors, which may serve as useful indicators for risk stratification and individualized treatment.