临床肝胆病杂志2017，Vol.33Issue(4)：674-678,5.DOI:10.3969/j.issn.1001-5256.2017.04.015
HBsAg阴性HBV相关肝细胞癌的临床特点
Clinical features of HBsAg-negative HBV-related hepatocellular carcinoma
摘要
Abstract
Objective To investigate the clinical features of HBsAg-negative HBV-related hepatocellular carcinoma (HCC).Methods The patients who were newly diagnosed with HCC from January 2005 to January 2012 were enrolled.According to the HBV-related serological markers,the patients were divided into HBsAg-negative HBV-related HCC group and hepatitis B-related HCC group.A retrospective analysis was performed for the clinical and laboratory examination data at initial diagnosis,including sex,age,hepatitis B virus markers,total bilirubin (TBil),albumin (Alb),alpha-fetoprotein (AFP),HBV DNA,body mass index (BMI),drinking history,history of diabetes,therapies,and follow-up results.The t-test was used for comparison of normally distributed continuous data between groups;the non-normally distributed data were expressed as median and interquartile range (Q1 and Q3),and the Wilcoxon rank sum test was used for comparison of non-normally distributed continuous data between groups;the chi-square test or Fisher's exact test were used for comparison of categorical data.The log-rank test was used to compare survival curves between the two groups,and the Kaplan-Meier method was used to calculate survival rates.Results Compared with the hepatitis B group and all patients,the HBsAg-negative group had a significantly higher mean age (59.42 ± 11.13 years) and significantly higher proportions of patients with age ＞ 60 years (46.85％),low body weight (12.24％),and overweight (20.98％) (all P ＜0.01).Compared with all patients and the hepatitis B group,the HBsAg-negative group had a significantly lower male-to-female ratio (2.86∶1),a significantly lower proportion of patients regularly undergoing physical examination every year (10.41％),a significantly lower HBV DNA positive rate (1.77％),and significantly lower proportions of patients with smoking and drinking histories (all P ＜0.01).Of all patients in the HBsAg-negative group,64.08％ had positive anti-HBs,anti-HBe,and anti-HBc,21.13％ had positive anti-HBe and anti-HBc,and 14.79％ only had positive anti-HBc.The HBsAg-negative group had a significantly lower AFP level than all patients and the hepatitis B group (P =0.039).Compared with the hepatitis B group and all patients,the HBsAg-negative group had a significantly higher proportion of multiple lesions,a significantly greater mean maximum tumor diameter,and a significantly higher number of patients with extrahepatic metastasis (all P ＜ 0.001).Compared with the hepatitis B group,the HBsAg-negative group had a higher proportion of patients with an Eastem Cooperative Oncology Group Performance Status score of 0 at initial diagnosis (17.69％) and a lower proportion of patients with early-to-medium Barcelona Clinic Liver Cancer stage (stages A and B) (30.26％ vs 51.60％,P ＜0.001);the number of patients with stages C and D in the HBsAg-negative group was 1.83 times that in the hepatitis B group (P ＜0.001).The HBsAg-negative group had a significantly lower median survival time (15.22 months) than all patients and the hepatitis B group (P =0.024、0.031).Compared with all patients and the hepatitis B group,the HBsAg negative group had significantly lower 1-and 3-year survival rates (1-year survival rate:56.0％ vs 61.7％ and 66.2％,x2 =4.93,P =0.026;3-year survival rate:24.0％ vs 45.2％ and 44.1％,x2 =6.867,P =0.009).Conclusion HBsAg-negative HBV-related HCC is commonly seen in patients aged ＞60 years with positive anti-HBs,anti-HBe,and anti-HBc.The population aged ＞60 years with HBV infection sbould be the high-risk population for HCC,and it is recommended to perform HCC screening every 6 months to increase the early diagnostic rate of HBsAg-negative HBV-related HCC.关键词
肝炎病毒,乙型/肝炎表面抗原,乙型/癌,肝细胞/疾病特征Key words
hepatitis B virus/hepatitis B surface antigens/carcinoma, hepatocellular/disease attributes分类
医药卫生引用本文复制引用
马燕,陈艳,安林静,曲建慧,王春平,杨永平..HBsAg阴性HBV相关肝细胞癌的临床特点[J].临床肝胆病杂志,2017,33(4):674-678,5.基金项目
全军医学科技“十二五”科研重点项目(BWS11J074) （BWS11J074）
国家自然基金课题(81272330) （81272330）
