巴塞罗那“中期”肝细胞癌各亚组患者肝切除术预后的比较  

Comparison of the prognosis after hepatic resection for patients with Barcelona Clinical Liver Cancer Stage B hepatocellular carcinoma

作　　者：覃宏贵 钟鉴宏[1] 向邦德[1] 吴飞翔[1] 彭宁福[1] 游雪梅[1] 袁卫平[1] 龚文锋[1] 马良[1] 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,广西肝癌诊疗工程技术研究中心,南宁530021

出　　处：《中华医学杂志》2016年第42期3384-3388,共5页National Medical Journal of China

基　　金：国家科技重大专项课题（2012ZX10002010001009）,广西卫生厅项目（GZZC15-34;S201417-02;S201417-03）,广西科技厅项目（桂科攻14124003-4）

摘　　要：目的比较接受肝切除术治疗的巴塞罗那“中期”肝细胞癌各亚组患者的总生存率，并研究疗效随时间的变化情况。方法连续性选取初次治疗方式为肝切除术的巴塞罗那中期肝细胞癌患者918例，分为3组：甲组：单个肿瘤且肿瘤直径≥5cm，582例；乙组：2—3个肿瘤且最大直径〉3cm，223例；丙组：3个以上肿瘤，n=113。比较3组患者在2001-2007年和2008-2013年的住院死亡率和总生存率。结果丙组患者的住院死亡率显著高于另外两组（P〈0．05），但丙组患者的1、3、5年总生存率显著低于乙组患者（P〈0．05），而乙组患者又显著低于甲组患者（P〈0．05）。甲、乙和丙3组患者的中位生存时间分别为47．3、36．9、和23．5个月。甲组和丙组患者在2008-2013年的总生存率显著优于2001-2007年（P〈0．05），但乙组患者在2008-2013年的总生存率仅稍优于2001-2007年（P=0．084）。结论3组患者的预后明显不同，肿瘤数量〉3的肝细胞癌患者行肝切除术后的住院死亡率最高而总生存率最低；随着手术技巧和围手术期护理技术的不断提高，肝切除术后肝细胞癌患者总生存率在不断提高。Objective To compare the efficacy of hepatic resection （HR） in patients with Barcelona Clinical Liver Cancer （BCLC） Stage B hepatocellular carcinoma （HCC） and examine how that efficacy has changed over time in a large medical center. Methods A consecutive sample of 918 patients with preserved liver function and large and/or multinodular HCC who were treated by initial HR were divided into three groups： those with a single tumor ≥5 cm in diameter （n = 582）, 2 -3 tumors with a maximum diameter 〉 3 em （ n = 223 ）, or 〉 3 tumors of any diameter （ n = 113 ）. Hospital mortality and overall survival （OS） in each group were compared for the years 2001 - 2007 and 2008 - 2013. Results Patients with 〉 3 tumors showed the highest incidence of hospital mortality of all groups （ P 〈 0. 05 ）. Kaplan-Meier survival analysis showed that OS varied across the three groups as follows： single tumor 〉 2 - 3 tumors 〉 3 ＋ tumors （ all P 〈 0. 05 ）. OS rate at 5 years ranged from 24% to 41% in all three groups for the period 2001 - 2007, and from 35% to 46% for the period 2008 -2013. OS was significantly higher during the more recent 6-year period in the entire patient population, those with single tumor, and those with 3 ＋ tumors （all P 〈 0. 05 ）. However, in patients with 2 - 3 tumors, OS was only slightly higher during the more recent 6-year period （P = 0. 084）. Conclusions Prognosis of three types of HCC was different. Patients with 〉 3 tumors show the highest hospital mortality and lowest OS after HR. OS has been improving for all three types of HCC at our medical center as a consequence of improvements in surgical technique and perioperative management.

关 键 词：巴塞罗那中期 肝细胞癌 肝切除术 总生存率 生存趋势 

分 类 号：R735.7[医药卫生—肿瘤]