肝切除术与TACE治疗原发性肝癌破裂出血疗效的倾向评分匹配分析  

Efficacy of hepatectomy and TACE for rupture and bleeding of primary liver cancer: a propensity score matching based analysis

作　　者：万文武 张瑜[1] 丁兵[1] 张勇[1] 凌俊[1] 方程 何攀 谢飞[3] 蒋辉[1,2] WAN Wenwu;ZHANG Yu;DING Bing;ZHANG Yong;LING Jun;FANG Cheng;HE Pan;XIE Fei;JIANG Hui(Department of Hepatobiliary Surgery,Neijiang Second People's Hospital,Neijiang,Sichuan 641000,China;Department of Hepatobiliary Surgery,Affiliated Hospital of Southwest Medical Universit,Luzhou,Sichuan 646000,China;Department of Hepatobiliary Surgery,Neijiang First People's Hospital,Neijiang,Sichuan 641000,China)

机构地区：[1]四川省内江市第二人民医院肝胆外科,四川内江641000 [2]西南医科大学附属医院肝胆外科,四川泸州646000 [3]四川省内江市第一人民医院肝胆外科,四川内江641000

出　　处：《中国普通外科杂志》2022年第1期22-30,共9页China Journal of General Surgery

基　　金：四川省科技计划-重点研发计划项目(2017SZYZF0015);成都高新医学会肿瘤介入专项科研基金课题(2020S02);四川省内江市重点科学技术项目(2019Z75)。

摘　　要：背景与目的:肝切除术(LR)和经导管动脉栓塞化疗术(TACE)都广泛应用于原发性肝癌(PLC)破裂出血的治疗,但相关疗效结果报道仍有较大差异。目前,在选择最合适的治疗策略以降低院内病死率和改善长期生存方面仍未达成共识。因此,本研究通过回顾性分析比较LR和TACE治疗PLC破裂出血的临床疗效和预后,以期为该病提供合理的治疗决策。方法:采用回顾性病例对照研究方法,选取2013年6月—2018年6月在三所医疗中心收治的195例PLC破裂患者,按治疗方式分为LR组(64例)和TACE组(131例)。用倾向性评分匹配(PSM)均衡一般资料后,比较两组患者的短期病死率与1、2、3年总体生存率(OS),并分析影响患者OS的危险因素。结果:按1∶1进行PSM后,两组患者共29对匹配成功。LR组与TACE组30 d病死率差异无统计学意义(3.4%vs.10.3%,P=0.611)。LR组和TACE组的1、2、3年OS率分别为75.9%、41.4%、12.9%与55.5%、14.4%、0;中位OS分别18.5(95%CI=12.9~24.1)个月和12.5(95%CI=10.4~14.6)个月,差异有统计学意义(χ;=4.843,P=0.028)。单因素分析显示,门静脉侵犯、门脉高压、腹水、肿瘤多发、肿瘤直径>10 cm、Child-Pugh分级、BCLC分期、AFP>400 ng/mL、治疗方式是影响PLC破裂出血患者OS的危险因素(均P<0.05);多因素Cox分析显示,肿瘤多发,Child-Pugh分级、AFP>400 ng/mL、治疗方式是影响PLC破裂出血患者OS的独立危险因素(均P<0.05)。结论:治疗方式是PLC破裂出血患者的独立预后因素,包含LR的综合治疗比TACE可以使此类患者取得更多的生存获益。Background and Aims: Liver resection(LR) and transcatheter arterial chemoembolization(TACE) are widely used in the treatment of rupture and bleeding of primary liver cancer(PLC). However, there are still great differences in the efficacy results from relevant reports. So far, the consensus on the most appropriate treatment strategy to reduce in-hospital mortality and improve long-term survival has not been established. Therefore, this study was conducted to compare the clinical efficacy and prognosis of LR and TACE in the treatment of PLC rupture and bleeding through a retrospective analysis, so as to provide the optimal treatment strategy for this condition.Methods: Using a retrospective case-control design, 195 patients with ruptured PLC treated in three medical centers from June 2013 to June 2018 were enrolled, and divided into LR group(64 cases) and TACE group(131 cases) according to the treatment methods. After balancing the baseline characteristics by propensity score matching(PSM), the 1-, 2-and 3-year overall survival(OS) rates between the two groups were compared, and the risk factors affecting the OS of patients were analyzed.Results: A total of 29 pairs of patients in the two groups were successfully matched after PSM with a 1∶1 ratio. There was no statistical difference in 30-d mortality between LR group and TACE group(3.4%vs. 10.3%, P=0.611). The 1-, 2-and 3-year OS rates were 75.9%, 41.4% and 12.9% for LR group, and were 55.5%, 14.4%, and 0 for TACE groups, respectively;the median OS was 18.5(95% CI=12.9-24.1)months for LR group and 12.5(95% CI=10.4-14.6) months for TACE group, and the difference had statistical significance(χ;=4.843, P=0.028). Univariate analysis showed that portal vein invasion, portal hypertension, ascites, multiple lesions, tumor diameter >10 cm, Child-Pugh grade, BCLC stage,AFP >400 ng/mL and treatment method were risk factors affecting the OS of patients with ruptured hemorrhagic PLC(all P<0.05);multivariate Cox analysis revealed that multiple lesions, Child-Pugh grade, AFP

关 键 词：肝肿瘤 破裂 自发性 肝切除术 化学栓塞 治疗性 倾向性评分 

分 类 号：R735.7[医药卫生—肿瘤]