关键词: 肝细胞癌, 骨转移, 治疗策略, 预后, 影响因素

Abstract:

Objective To explore the relationship between therapy and survival of hepatocellular carcinoma bone metastasis(HCC-BM) patients, and analyze the factors aff ecting the survival of HCC-BM patients. Method The clinical data of HCC-BM patients admitted to Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2019 to January 2023 were retrospectively analyzed, the Kaplan-Meier method was used to calculate the median survival time and draw the survival curve. Log-Rank test was used for comparison between groups with or without primary tumor treatment, with or without bone metastasis treatment, and various treatment regimens for primary tumor. Factors that may affect the survival of patients such as gender, age, alpha-fetoprotein were included in the Cox regression model for univariate regression analysis, and signifi cant variables were included in the multivariate Cox regression model to identify the independent risk factors aff ecting the survival of HCC-BM patients. Result A total of 81 HCC-BM patients were enrolled, the median interval of HCC-BM patients was 10.5 months, the median survival time was 7.3 months, and the 1-, 2-, and 3-year survival rates were 37.0%, 17.3%, and 6.2%, respectively. Log-Rank test showed that there were statistically signifi cant diff erences in survival time between HCC-BM patients with or without primary tumor treatment, monotherapy or combination therapy and HCC-BM patients without primary tumor treatment, and bone metastasis treatment or not (all P ＜ 0.05). Univariate regression analysis showed that alpha-fetoprotein and alkaline phosphatase levels, vascular invasion, Child-Pugh score, number of bone metastases, systemic multiple bone metastases, treatment of the primary tumor, treatment of bone metastases, and targeted combined immunotherapy were associated with the prognosis of HCC-BM patients (all P ＜ 0.05). Multivariate regression analysis showed that alpha-fetoprotein ≥ 400μg/L, systemic multiple bone metastases, no primary tumor treatment, and no targeted combined immunotherapy were independent risk factors for poor prognosis of HCC-BM patients (all P ＜ 0.05). Conclusion The morbidity of HCC-BM is high, and the interval and survival time of HCC-BM are short. Treatment of bone metastases can prolong the survival of HCC- BM patients. Combined therapy targeting the primary lesion significantly improves survival outcomes in HCC- BM patients, which is expected to become a better choice for HCC-BM treatment. Alpha-fetoprotein ≥ 400μg/L, systemic multiple bone metastases, no primary tumor treatment, and no targeted therapy combined immunotherapy are independent risk factors for poor prognosis of HCC-BM patients.

Key words: Hepatocellular carcinoma, Bone metastasis, Therapeutic strategy, Prognosis , Infl uence factor