原发性肝细胞癌根治术后行肝动脉化疗栓塞术生存分析  

Survival analysis of primary hepatocellular carcinoma radical resection adjuvant TACE

作　　者：鲁磊[1,2] 肖开银[2] 朱广志[2] 廖锡文[2] 韩创业 陈治伟[2] 覃玮[2] 叶新平[2] 陈滨[2] 尚丽明[2] 苏智雄[2] 苏铭[2] 文张[2] 陈希纲[2] 郭雅[2] 彭民浩[2] 彭涛[2] LU Lei;XIAO Kai -yin;ZHUGuang- zhi;LIAO Xi -wen;HAN Chuang -ye;CHEN Zhi -wei;QIN Wei;YE Xin -ping;CHEN Bin;SHANG Li -ruing;SU-Zhi xiong;SU Ming;WEN Zhang;CHEN Xi-gang;GUO Ya;PENG Min-hao;PENG Tao(Department of General Surgery ,Beijing Haidian Hospital · Beijing Haidian Section of Peking University Third Hospital, Beijing 100080, P. R. China;Department of Hepatobiliary Surgery ,First Affiliated Hospital of Guangxi Medical University, Nanning 530021 ,P. R. China)

机构地区：[1]北京市海淀医院.北京大学第三医院海淀院区普外科,北京100080 [2]广西医科大学第一附属医院肝胆外科,广西南宁530021

出　　处：《中华肿瘤防治杂志》2018年第4期263-269,共7页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家自然科学基金(81560535);广西医疗卫生重点科研课题(重201018);广西科学研究与技术开发计划(桂科攻1104003A-7)

摘　　要：目的由于原发性肝细胞癌的早期症状比较隐匿,大多数患者确诊时已经是中晚期,彻底根治较为困难。但是随着人们对肝癌治疗认识的不断深入,术后应用辅助性治疗得到了业界的广泛认可。本研究通过回顾性分析比较原发性肝癌根治术及术后行经导管肝动脉介入化疗栓塞(transcatheter arterial chemoembolization,TACE)对原发性肝癌的治疗效果,综合分析影响肝癌患者预后的因素。方法回顾性分析2007-01-01—2011-10-31在广西医科大学第一附属医院肝胆外科诊断为原发性肝癌的患者资料共170例,观察组(n=85)为肝癌根治性切除术后行TACE介入治疗组,对照组(n=85)为单纯行肝癌根治性切除组。使用Log-rank检验进行分组变量之间的生存分析,Cox风险模型分析影响肝癌切除术及术后行TACE介入治疗效果的独立预后因素。结果观察组1、2、3和5年的累积生存率分别为85.9%(73/85)、81.2%(69/85)、72.9%(62/85)和47.1%(40/85)。1、2、3和5年的复发率分别为50.6%(43/85)、70.6%(60/85)、72.9%(62/85)和81.2%(69/85)。而对照组1、2、3和5年的累积生存率分别为82.4%(70/85)、68.2%(58/85)、60.0%(51/85)及27.1%(23/85)。1、2、3和5年的复发率分别为51.8%(44/85)、65.9%(56/85)、75.3%(64/85)及80.0%(68/85)。Cox回归多因素分析显示,肿瘤肝内转(HR=6.601,95%CI为1.502~20.549,P=0.010)、术前甲胎蛋白(alpha fetoprotein,AFP)值(HR=4.357,95%CI为1.096~18.136,P=0.037)是总生存时间的影响因素。而肿瘤肝内转移(HR=5.640,95%CI为1.160~27.415,P=0.032)、肿瘤直径(HR=7.713,95%CI为1.521~39.112,P=0.014)和镜下癌栓(HR=5.698,95%CI为1.187~27.343,P=0.030)是无瘤生存时间的独立预后因素。结论对于术前AFP≥400μg/L、肿瘤直径≥5cm及术前出现肝内转移的患者,术后行TACE可延长无瘤生存时间及总生存时间,降低肿瘤复发的概率。OBJECTIVE Due to that the early symptoms of primary hepatocellular carcinoma are more occult,most patients are already in advanced stages when diagnosed,and complete eradication is more difficult.However,with the deepening of people＇s understanding of liver cancer treatment,postoperative adjuvant therapy has been widely recognized in the industry.In this study,we retrospectively analyzed and compared the therapeutic effects of the radical resection of primary hepatocellular carcinoma with transcatheter arterial chemoembolization（TACE）after surgery on primary hepatocellular carcinoma,and comprehensively analyzed the factors affecting the prognosis of patients with hepatocellular carcinoma.METHODS Totally 170 cases of patients diagnosed as primary hepatocellular carcinoma in the First Affiliated Hospital of Guangxi Medical University from 2007-01-01 to 2011-10-31 were retrospectively analyzed.The observation group received the TACE intervention after the radical resection of primary hepatocellular carcinoma,and the control group underwent the simply radical resection of primary hepatocellular carcinoma.Log-rank test was used to analyze the survival of grouped variables.The Cox risk model was used to analyze independent prognostic factors affecting the therapeutic effects of the radical resection of primary hepatocellular carcinoma and TACE after surgery.RESULTS The cumulative survival rates of the observation group at 1,2,3 and 5 years were 85.9%（73/85）,81.2%（69/85）,72.9%（62/85）,and 47.1%（40/85）,respectively.The recurrence rates at 1,2,3 and 5 years were 50.6%（43/85）,70.6%（60/85）,72.9%（62/85）and 81.2%（69/85）,respectively.The cumulative survival rates of the control group at 1,2,3 and 5 years were82.4%（70/85）,68.2%（58/85）,60.0%（51/85）and 27.1%（23/85）,respectively,and the recurrence rates at 1,2,3 and5 years were 51.8%（44/85）,65.9%（56/85）,75.3%（64/85）and 80.0%（68/85）,respectively.Cox regression multivariate analysis showed that intrahepatic metasta

关 键 词：原发性肝细胞癌 介入治疗 肿瘤复发 生存分析 

分 类 号：R735.7[医药卫生—肿瘤]