三种不同方式治疗原发性肝癌患者的远期预后对比分析  

Long-term prognosis of patients with primary liver cancer treated by three different methods

作　　者：王征夏[1] 尹思能[1] 索运生[1] WANG Zhengxia;YI Sineng;SUO Yunsheng(Department of General Surgery, The Second People's Hospital of Chengdu,Chengdu 610000,China)

机构地区：[1]成都市第二人民医院普外二科

出　　处：《西部医学》2019年第7期1061-1066,共6页Medical Journal of West China

基　　金：四川省卫生和计划生育委员会科研课题(17PJ180)

摘　　要：目的探讨三种不同方式治疗原发性肝癌(PLC)患者的远期预后价值。方法选取2008年1月~2014年12月我院收治的124例PLC患者作为研究对象,采用回顾性分析法分析所有患者的临床及随访资料,根据不同治疗方法将其分为A组(n=46)、B组(n=52)和C组(n=26)。所有患者均予以护肝等对症基础治疗,A组患者在此基础上予以肝动脉插管栓塞化疗(TACE)介入治疗,B组患者予以TACE联合手术治疗,C组患者予以TACE联合三维适形放疗(3D-CRT)进行治疗。治疗结束后记录所有患者性别、年龄、疾病情况等一般临床资料和相关临床指标,近期临床疗效及远期预后生存情况,并比较3组患者上述资料的差异性;分析影响原发性肝癌患者远期预后的相关因素。结果治疗后3组近期临床总有效率比较差异均无统计学意义(P>0.05);124例PCL患者预后总中位生存时间为26.8个月,且不同随访时间点B组和C组的预后生存率均显著高于A组,其中3年远期生存率也显著升高(P<0.05),但不同时间点B组和C组的预后生率比较差异均无统计学意义(P>0.05);经Log-rank检验单因素分析显示,不同肝功能分级、临床分期、AFP水平、治疗方式、有无门静脉栓、肝硬化和淋巴结转移是影响PLC患者预后的因素(P<0.05);经多元逐步Cox回归分析显示门静脉栓、肝硬化和淋巴结转移及仅采用TACE治疗均为影响PLC患者预后的独立危险因素(P<0.05)。结论与单纯TACE相比较,TACE联合手术治疗和TACE联合3D-CRT治疗可更进一步地提高PLC患者远期预后生存率,更适用于临床上PLC的治疗。Objective To investigate the long-term prognostic value of three different modes of treatment for patients with primary liver cancer(PLC). Methods 24 patients with PLC treated in our hospital from January 2008 to December 2014 were selected as the study subjects. The clinical and follow-up data of all patients were analyzed by retrospective analysis. They were divided into group A(46 cases), group B(52 cases) and group C(26 cases). All patients were treated with symptomatic treatment. Group A was treated with TACE intervention on this basis. Group B was treated with TACE. Group C was treated with TACE and 3 D-CRT. At the end of the treatment, the general clinical data including gender, age, disease status and related clinical indicators, recent clinical efficacy, and long-term prognosis of survival were recorded. Compare the differences of the above data among the three groups of patients and analyze the factors that influence the long-term prognosis of patients with primary liver cancer. Results There was no significant difference in clinical total effective rate among the three groups of PLC patients after treatment(P>0.05). From the time of discharge from hospital to the end of follow-up, the median survival time of 124 patients with PCL was 26.8 months, and the prognosis survival rates of PLC patients in group B and C at different follow-up time points were significantly higher than those of PLC patients in group A. The 3-year survival rate was also significantly increased(P<0.05), but there was no difference in the prognosis survival rate of PLC patients between group B and C at different time points(P>0.05). Single factor analysis by Log-rank test showed that there were differences in survival time among PLC patients with different liver function classification, clinical stage, AFP level, treatment method, and with or without portal vein suppository, cirrhosis, and lymph node metastasis(P<0.05). Multivariate stepwise Cox regression analysis showed that portal vein suppository, cirrhosis and lymph node metas

关 键 词：肝动脉插管栓塞化疗 手术 放疗 原发性肝癌 远期预后 

分 类 号：R735.7[医药卫生—肿瘤]