原发性肝癌的介入综合治疗及其预后影响因素

Analysis of combinated transcatheter hepatic artery chemoembolization and factors affecting the prognosis in patients with primary hepatic carcinoma

目的评价原发性肝细胞肝癌肝动脉化疗栓塞(TACE)为主的综合治疗,分析、筛选与预后相关的因素。方法141例原发性肝细胞肝癌分别采用TACE治疗、TACE+手术切除、TACE+ PEI治疗和TAI治疗。根据多因素回归模型,对患者年龄、性别、血清AFP、ALT、HBsAg、肝功能Child分级、治疗方式、肿瘤大小及数目、血清白蛋白水平、门静脉癌栓、肿瘤病理类型和血清HBeAg进行预后分析。结果本组患者的总体中位生存时间为19个月,平均生存23．59个月。1、2、3、5年生存率分别为63．9％、44．5%、25．8％和7．4％。多因素分析显示,患者年龄、肝功能Child分级、治疗方式、门静脉癌栓和肿瘤病理类型与TACE综合治疗预后有关(x2=45．993,P=0．0001)。结论原发性肝细胞肝癌介入综合治疗安全、有效。患者年龄、肝功能Child分级、门静脉癌栓和肿瘤病理类型是影响介入综合治疗预后的危险因素,治疗方式是影响预后的保护性因素。

Objective To evaluate the combinated transcatheter hepatic artery chemoembolization （TACE） and analyse the factors affecting prognosis in patients with primary hepatic carcinoma. Methods 141 consecutive patients with primary hepatic carcinoma were treated, including 125 men and 16 women （ mean age, 52 years; age range, 21 -76 years ）. Combinated TACE procedures included TACE, TACE followed by surgical resection, TACE and percutaneous ethanol injection （PEI） and transcatheter hepatic artery infusion （TAI）. The factors included sex, age, ALT, AFP, HBsAg, liver function （Child＇s system）, the way of treatment, tumor size and number, serum albumin, portal cancerous thrombus, pathological type of tumors, and HBeAg. The Cox＇s regression analysis model was used to analyse the factors affecting the prognosis. P 〈 0.05 means statistically significant difference. Results The total median survival time was 19 months and mean survival time 23.59 months. The total survival rates of 1, 2, 3, 5 years were 63.9%, 44.5% , 25.8% and 7.4% , respectively. Muhivariable analysis revealed significant prognostic factors as follows： age, liver function, the way of treatment, portal cancerous thrombus and pathological types of tumors（X^2 = 45. 993, P = 0.0001 ）. Conclusion The combinated TACE procedure is safe and effective. In this study, 5 factors directly influencing the prognosis are age, liver function, portal cancerous thrombus and pathological types of tumors are risk prognostic factors, and the way of treatment is a protective factor（x^2 = 45.993, X^2 =0.000）.