274例巴塞罗那A期肝癌经肝动脉化疗栓塞治疗的预后分析  

A study on factors influencing survival of 274 BCLC stage A HCC patients treated with transarterial chemoembolization

作　　者：杨浩洁[1] 郭哲[1] 姜经航 杨富权 鲍思扬 黎乐群[1] 赵昌[2] 向邦德[1] 

机构地区：[1]广西医科大学附属肿瘤医院肝胆外科,南宁530021 [2]广西医科大学附属肿瘤医院介入科,南宁530021

出　　处：《中华普通外科杂志》2015年第3期185-188,共4页Chinese Journal of General Surgery

基　　金：国家自然科学基金资助项目（81260331）;国家科技重大专项课题基金资助项目（2012ZX10002010001009）

摘　　要：目的 探讨巴塞罗那分期（Barcelona Clinical Liver Cancer Staging System,BCLC）A期肝癌患者经肝动脉化疗栓塞（transarterial chemoembolization,TACE）治疗预后的影响因素. 方法 回顾性分析274例经TACE治疗的BCLC A期肝癌患者的临床资料.结果 BCLC A期肝癌患者术后1、3、5年生存率分别为51.6％、21.2％、11.8％.单因素分析表明术前白蛋白≤35 g/L（x2=6.736,P=0.009）、天冬氨酸转氨酶≥70 U/L（x2=8.295,P=0.004）、肿瘤直径≥5 cm（x2=6.720,P=0.010）、AFP≥400 ng/ml（x2=12.510,P=0.000）影响BCLC A期肝癌患者术后累积生存率.多因素分析表明术前白蛋白≤35 g/L（Wald=9.827,P=0.002）、肿瘤直径≥5 cm（Wald=5.680,P=0.017）、AFP（α-fetoprotein）≥400 ng/ml（Wald=10.359,P=0.001）是影响上述患者预后的独立危险因素.另外,满足白蛋白＞ 35 g/L、肿瘤直径＜5 cm、AFP ＜400 ng/ml的BCLC A期患者1、3、5年生存率为83.3％、61.1％、30％.结论 术前白蛋白≤35 g/L、肿瘤直径≥5 cm、AFP≥400 ng/ml是影响BCLC A期肝癌患者预后的独立危险因素;对于满足白蛋白＞ 35 g/L、肿瘤直径＜5 cm、AFP＜ 400 ng/ml的BCLC A期肝癌患者,TACE是一种安全、有效的治疗手段.Objective To study prognostic factors in BCLC （Barcelona Clinical Liver Cancer Staging System） stage A hepatocellular carcinoma （HCC）patients treated with TACE （transarterial chemoembolization）.Methods The clinical data of 274 patients with BCLC stage A HCC treated with TACE were retrospectively analyzed.Results The 1-,3-and 5-year overall survival rates were 51.6％,21.2％ and 11.8％,respectively.According to the log-rank test,preoperative serum albumin level ≤ 35 g/L（x2 =6.736,P =0.009）,preoperative serum AST （aspartate aminotransferase） ≥ 70 U/L （x2 =8.295,P =0.004）、tumor size ≥ 5 cm （x2 =6.720,P =0.010） and AFP （α-fetoprotein）level ≥ 400 ng/ml （x2 =12.510,P =0.000） were significantly associated with prognosis of stage A HCC,and Cox regression indicated that independent prognostic factors included serum albumin level ≤ 35 g/L （Wald =9.827,P =0.002）,tumor size ≥ 5 cm （Wald =5.680,P =0.017） and AFP （α-fetoprotein）level ≥400 ng/ml （Wald =10.359,P =0.001）.The 1-,3-and 5-year overall survival rate for BCLC stage A HCC patients with serum albumin level ＞ 35 g/L,AFP level ＜ 400 ng/ml and tumor size ＜ 5 cm was 83.3％,61.1％ and 30％,respectively.Conclusions Serum albumin level ≤35 g/L,AFP level ≥ 400 ng/ml and tumor size ≥ 5 cm were the main risk factors affecting the prognosis.TACE is an effective treatment for BCLC stage A HCC with serum albumin level ＞ 35 g/L,AFP level ＜ 400 ng/ml and tumor size ＜5 cm.

关 键 词：癌 肝细胞 化学栓塞 治疗性 抗肿瘤联合化疗方案 

分 类 号：R735.7[医药卫生—肿瘤]