Analysis of clinical characteristics and prognosis of 17 elderly patients with primary liver cancer complicated with inferior vena cava-right atrial cancer thrombus
Objective To summarize the clinical data(age,gender,laboratory tests,etc.),treatment methods,and prognosis of patients with primary liver cancer(PLC)complicated with inferior vena cava(IVC)-right atrial(RA)tumor thrombosis.Methods The method of statistical description was adopted.The clinical data of 17 patients with PLC complicated with IVC-RA tumor thrombosis treated in Beijing Ditan Hospital Affiliated to Capital Medical University were collected,and their laboratory examination,treatment and prognosis were summarized and analyzed.Results Among the 17 patients,there were 12 males and 5 females,with an average age of(76.8±15.2)years.The average age at initial diagnosis of PLC was(76.1±15.7)years.The median survival time from diagnosis of PLC to involvement of IVC-RA was 5(1-40)months.All 17 patients had cirrhosis,with Child-Pugh class A in 7 cases,class B in 6 ones,and class C in 4 ones.The tumors were multi-ple in 14 patients,with a largest tumor diameter of(72.35±35.47)mm.AFP level＞400 ng/ml in 10 patients.Barcelona Clinic Liver Cancer(BCLC)stage C in 15 cases and stage D in 2 ones.The females had higher levels of alanine aminotrans-ferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),direct bilirubin(DBIL),international normalized ratio(INR),and aspartate aminotransferase-to-platelet ratio index(APRI)than the males(P＜0.05).The males had shorter prothrombin time(PT)than the females(P＜0.05)and higher prothrombin activity(PTA)(P＜0.05).Six patients received only conservative treatment,while the other patients received single or combined hepatic arterial chemoembolization,ablation,targeted therapy,and immunotherapy.The median survival time of the patients was 5(1～40)months.Kaplan-Meier univari-ate and Cox regression multivariate analysis showed that age was a protective factor for the prognosis of PLC patients,while conservative treatment alone and ALT were independent risk factors for the prognosis of patients.Conclusion IVC-RA tumor thrombosis mostly occurs in patients with advanced stage of PLC.Multiple tumors are common,AFP level is mostly higher,and the higher the ALT,the shorter the survival period.The treatments such as arterial chemoembolization,ablation,targeted therapy and immunotherapy can prolong the survival time of patients.
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