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中华介入放射学电子杂志 ›› 2021, Vol. 09 ›› Issue (03) : 258 -265. doi: 10.3877/cma.j.issn.2095-5782.2021.03.004

肿瘤介入

性别对肝癌微创介入治疗预后的影响研究
王琦1, 刘博君2, 扈彩霞2, 郑加生2, 张永宏2,()   
  1. 1. 100069 北京,首都医科大学附属北京佑安医院生物医学信息中心
    2. 100069 北京,首都医科大学附属北京佑安医院肝病与肿瘤介入治疗中心
  • 收稿日期:2021-01-11 出版日期:2021-08-25
  • 通信作者: 张永宏
  • 基金资助:
    北京市自然科学基金重点项目(7191004); 北京市医院管理局"登峰"人才培养计划(DFL20181701); 首都卫生发展科研专项项目(2020-1-2182)

Influence of gender on prognosis of patients with hepatocellular carcinoma undergoing minimally invasive interventional therapy

Qi Wang1, Bojun Liu2, Caixia Hu2, Jiasheng Zheng2, Yonghong Zhang2,()   

  1. 1. Research Center for Biomedical Rresources, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
    2. Interventional Therapy Center for Oncology, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
  • Received:2021-01-11 Published:2021-08-25
  • Corresponding author: Yonghong Zhang
  • About author:
    Co-first authors: Wang Qi, Liu Bojun
引用本文:

王琦, 刘博君, 扈彩霞, 郑加生, 张永宏. 性别对肝癌微创介入治疗预后的影响研究[J/OL]. 中华介入放射学电子杂志, 2021, 09(03): 258-265.

Qi Wang, Bojun Liu, Caixia Hu, Jiasheng Zheng, Yonghong Zhang. Influence of gender on prognosis of patients with hepatocellular carcinoma undergoing minimally invasive interventional therapy[J/OL]. Chinese Journal of Interventional Radiology(Electronic Edition), 2021, 09(03): 258-265.

目的

探讨在接受微创治疗即经动脉化疗栓塞联合消融治疗的肝细胞癌(HCC)患者基于不同性别的预后是否存在差异。

方法

回顾性分析2012年1月1日至2016年12月31日于我院行经动脉化疗栓塞联合局部消融治疗的806例HCC患者。采用标准倾向评分匹配(PSM)来创建两个高度可比组;Kaplan-Meier法计算累积无复发生存率(RFS)和总生存率(OS);Cox比例危险模型筛选HCC患者复发和长期预后的独立预测因素。

结果

女性较男性有更长的1、3和5年RFS率(女性:79.0%、54.6%、49.6%;男性:68.4%、40.4%、33.4%,P < 0.001),这和经PSM处理方法后的结果一致。男性和女性有不同的复发危险因素谱,年龄、肿瘤数目、肿瘤大小、中性粒细胞、球蛋白、γ-谷氨酰转肽酶以及甲胎蛋白均可影响男性的复发,但对于女性,只有年龄和球蛋白是独立的预测指标。

结论

女性HCC患者的预后比男性好。性别之间的预后差异可能表明基于性别的分层在HCC患者术前评估和预后管理中的重要性。

Objective

To investigate whether there was a difference in gender-based outcomes among patients with HCC who underwent transcatheter arterial chemoembolization (TACE) combined with locoregional ablation therapy.

Methods

A retrospective analysis was conducted on 806 patients with HCC who were treated with TACE combined with local ablation in Beijing You'an Hospital affiliated to Capital Medical University from January 1, 2012 to December 31, 2016. Standard propensity score matching was performed to create two highly comparable groups. The cumulative recurrence-free survival (RFS) and overall survival (OS) rates were calculated by Kaplan-Meier method, and the Cox proportion hazard model was conducted to screen for independent predictive factors for indicating recurrence and long-term prognosis of HCC patients.

Results

Women had better 1, 3, and 5-year RFS rates (79.0%, 54.6%, 49.6% vs 68.4%, 40.4%, 33.4%, P < 0.001), which was consistent with the consequences of data processed by PSM method. There were different risk factor spectrum for recurrence between men and women. Age, tumor number, tumor size, neutrophils, globulin, GGT, together with alpha fetoprotein (AFP) could influence recurrence for men, however for women, only age and globulin were independent predictors.

Conclusions

Women have a better prognosis than men. Prognosis difference with respect to gender may indicate the significance of gender-based stratification in preoperative evaluation and prognostic management of HCC patients.

图1 患者筛选流程
图2 基于性别的临床资料比较
表1 男性和女性的基线特征比较
图3 基于性别的RFS和OS比较
图4 倾向评分匹配方法处理后的基于性别的RFS和OS比较
表2 PSM法处理后基于性别的基线特征比较
图5 基于年龄的复发和生存分析条形图
图6 基于性别和年龄的RFS和OS比较
表3 影响男性肝癌复发的单、多因素分析
变量 单因素分析 多因素分析
HR(95%CI P HR(95%CI P
年龄 1.41(1.13~1.76) 0.003 1.56(1.19~2.03) 0.001
高血压 0.95(0.74~1.22) 0.707    
糖尿病 1.06(0.81~1.38) 0.695    
病因        
  HCV 1.41(1.00~1.97) 0.047 1.08(0.70~1.68) 0.727
  其他 0.93(0.56~1.54) 0.784 0.69(0.24~1.96) 0.486
Child-Pugh分级 1.29(1.02~1.63) 0.032 1.12(0.86~1.47) 0.398
肝硬化 1.40(1.02~1.94) 0.040 1.29(0.86~1.94) 0.225
肿瘤数目 1.56(1.24~1.96) < 0.001 1.58(1.21~2.06) < 0.001
肿瘤大小 1.76(1.42~2.19) < 0.001 1.66(1.27~2.17) < 0.001
白细胞 0.91(0.67~1.24) 0.560    
中性粒细胞 1.19(0.96~1.47) 0.108 1.30(1.00~1.67) 0.043
淋巴细胞 0.86(0.70~1.07) 0.171    
血小板 0.86(0.69~1.08) 0.204    
谷丙转氨酶 1.30(1.05~1.61) 0.015 1.05(0.80~1.39) 0.720
谷草转氨酶 1.46(1.17~1.82) < 0.001 1.04(0.77~1.40) 0.805
总胆红素 1.35(1.08~1.70) 0.008 1.02(0.78~1.35) 0.862
尿素氮 0.79(0.64~0.98) 0.035 0.81(0.63~1.05) 0.115
总蛋白 1.04(0.84~1.29) 0.699    
白蛋白 0.56(0.45~0.69) < 0.001 0.82(0.61~1.11) 0.199
球蛋白 1.46(1.18~1.81) < 0.001 1.34(1.03~1.74) 0.029
前白蛋白 0.60(0.48~0.76) < 0.001 0.76(0.56~1.03) 0.076
总胆固醇 0.85(0.69~1.06) 0.157    
γ-谷氨酰转肽酶 1.67(1.34~2.08) < 0.001 1.38(1.04~1.84) 0.024
碱性磷酸酶 1.44(1.12~1.85) 0.005 1.15(0.84~1.57) 0.374
国际标准化比值 1.35(0.98~1.87) 0.066    
凝血时间 1.40(1.09~1.81) 0.009 0.94(0.68~1.29) 0.693
活化部分凝血活酶时间 1.34(1.06~1.70) 0.016 1.31(0.99~1.75) 0.063
纤维蛋白原 1.23(0.98~1.56) 0.080    
甲胎蛋白(ng/mL)        
  7~400 1.53(1.22~1.92) < 0.001 1.40(1.06~1.85) 0.017
  > 400 1.50(1.03~2.18) 0.036 1.38(0.89~1.75) 0.147
病毒载量(U/mL)        
  1 000~20 000 1.57(1.13~2.19) 0.007 1.36(0.95~1.96) 0.092
  > 20 000 1.26(0.96~1.65) 0.095 0.83(0.60~1.16) 0.278
表4 影响女性肝癌复发的单、多因素分析
变量 单因素分析 多因素分析
HR(95%CI P HR(95%CI P
年龄 3.01(1.29~7.00) 0.011 2.89(1.13~7.42) 0.027
高血压 1.08(0.60~1.91) 0.792    
糖尿病 0.72(0.29~1.81) 0.487    
病因        
  HCV 1.20(0.36~1.49) 0.386    
  其他 1.01(0.56~2.41) 0.995    
Child-Pugh分级 1.16(0.66~2.04) 0.599    
肝硬化 1.25(0.65~2.40) 0.505    
肿瘤数目 1.47(0.84~2.58) 0.179    
肿瘤大小 1.73(1.00~2.98) 0.047 1.54(0.84~2.82) 0.164
白细胞 1.77(0.92~3.41) 0.086    
中性粒细胞 1.50(0.90~2.48) 0.116    
淋巴细胞 0.79(0.47~1.30) 0.350    
血小板 0.83(0.49~1.40) 0.482    
谷丙转氨酶 0.98(0.58~1.66) 0.946    
谷草转氨酶 1.73(0.99~3.02) 0.056 1.08(0.56~2.08) 0.817
总胆红素 1.14(0.65~1.97) 0.652    
尿素氮 0.50(0.29~0.83) 0.008 0.65(0.36~1.17) 0.152
总蛋白 1.50(0.91~2.49) 0.115    
白蛋白 0.82(0.49~1.39) 0.466    
球蛋白 1.80(1.09~3.01) 0.022 1.90(1.02~3.52) 0.042
前白蛋白 0.95(0.52~1.76) 0.875    
总胆固醇 0.78(0.46~1.32) 0.346    
γ-谷氨酰转肽酶 1.33(0.80~2.22) 0.272    
碱性磷酸酶 1.03(0.57~1.84) 0.927    
国际标准化比值 2.27(1.03~5.01) 0.042 1.66(0.64~2.57) 0.297
凝血时间 1.21(0.70~2.10) 0.499    
活化部分凝血活酶时间 1.41(0.84~2.35) 0.195    
纤维蛋白原 1.73(1.00~3.00) 0.050 1.32(0.68~3.77) 0.411
甲胎蛋白(ng/mL)        
  7~400 0.97(0.56~1.70) 0.916    
  > 400 1.40(0.56~3.51) 0.471    
病毒载量(U/mL)        
  1 000~20 000 1.22(0.53~2.77) 0.640 1.21(0.49~3.01) 0.684
  > 20 000 1.88(1.05~3.35) 0.032 1.93(0.98~3.78) 0.056
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