肝切除与肝动脉化疗栓塞治疗大肝癌的疗效比较  

Survival comparison between hepatic resection and transarterial chemoembolization for matched patients with large hepatocellular carcinoma

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

出　　处：《中华普通外科杂志》2015年第4期290-293,共4页Chinese Journal of General Surgery

基　　金：国家自然科学基金资助项目（81260331;81160262）;国家科技重大专项课题基金资助项目（2012ZX10002010001009）

摘　　要：1目的比较大肝癌患者经肝切除与肝动脉化疗栓塞（transarterial chemoembolization，TACE）治疗的疗效。方法回顾性分析2003年3月至2008年3月454例行肝切除或TACE治疗肝功能Child—PughA级大肝癌患者的临床资料，其中肝切除组221例，TACE组233例。采用倾向得分匹配法（propensity score matching，PSM）均衡组间混杂因素的影响，对匹配后两组患者进行生存分析。结果共计133对患者匹配成功。肝切除组及TACE组中位生存期分别为33．4个月和20．7个月，1、3、5年累计生存率分别为74．9％、43．5％、31．9％和54．6％、17．1％、11．0％（X2=22．506，P〈0．001）。采用Cox模型对可能影响患者预后的有关因素进行分析，结果提示TACE治疗（Wald=37．060，P〈0．001）、白蛋白〈35g/L（Wald=7．771，P=0．005）、天冬氨酸转氨酶≥80U／L（Wald=4．775，P=0．029）及甲胎蛋白t〉400ng／ml（Wald=12．861，P〈0．001）是影响上述患者预后的独立危险因素。结论肝切除较TACE可明显提高肝功能Child—PughA级大肝癌患者的远期生存率。Objective To compare the long-term survival of matched patients with large hepatocellular carcinoma （HCC） who received hepatic resection or transarterial chemoembolization （TACE）. Methods A total of 221 and 233 large HCC patients with Child-Pugh A liver function undergoing hepatic resection （HR）or TACE, were retrospectively evaluated. To adjust for baseline differences, propensity-score matching was used to generate matched patients. Long-term survival was compared by Kaplan-Meier method. Independent prognostic predictors were determined by Cox proportional hazards model. Results After propensity score analysis to adjust for baseline differences, 133 pairs of matched patients were selected from each treatment arm. Median survival time was 33.4 months in the HR group and 20.7 months in the TACE group. The 1 - , 3 - , and 5 - year survival rates were significantly higher in the HR group （74.9% , 43.5% , 31.9% ） than in the TACE group （54. 6%, 17. 1%, 11.0% ; X2 =22. 506,P 〈0. 001 ）. Four independent prognostic factors were found in association with worse overall survival ： TACE treatment（ Wald = 37.060, P 〈 0. 001 ）, serum albumin 〈 35 g/L （ Wald = 7. 771, P = 0. 005）, serum aspartate aminotransferase（AST） ≥80 U/L（Wald =4. 775, P =0. 029）, and serum alphafetoprotein（AFP） level t〉 400 ng/ml （ Wald = 12. 861, P 〈 0. 001 ）. Conclusions Hepatic resection provides better long-term survival than TACE for large HCC patient.

关 键 词：癌 肝细胞 肝切除术 化学栓塞 治疗性 存活率分析 

分 类 号：R735.7[医药卫生—肿瘤]