经肝动脉化疗栓塞的化疗剂量及治疗间隔时间对III期肝癌患者病死风险及生存期的影响

The Survival Analysis of the Patients with Unresectable Hepatocellular Carcinoma after Transcatheter Arterial Chemoembolization and the Hazard Ratio of Transcatheter Arterial Chemoembolization in Different Dosage and Different Interval

目的:分析经导管肝动脉化疗栓塞(TACE)的化疗剂量及治疗间隔对III期肝癌患者病死风险及生存期的影响。方法:106例不能手术切除的III期肝癌患者单纯接受TACE治疗,根据TACE治疗中化疗药物的应用剂量分为低剂量组(33例)和常规剂量组(39例);根据TACE的治疗间隔时间分为短间隔组(24例,<6周)和长间隔组(25例,≥6周);随访至患者死亡。分析TACE的化疗药物剂量与治疗间隔时间对肝癌患者相对病死风险及生存期的影响及组间差异。结果:单因素生存分析显示,1年和2年的生存率:低剂量组分别为15.15%(5/33)及0%(0/33),常规剂量组分别为23.08%(9/39)及0%(0/39),两组差异无统计学意义(P=0.113);短间隔组分别为13.64%(1/24)和0%(0/24),长间隔组分别为20%(5/25)及4%(1/25)。两组生存时间比较差异有统计学意义(P=0.020)。多因素分析显示,TACE治疗后肝功能Child-Pugh分级、TACE次数和TA-CE治疗间隔时间是独立的相对危险因素。结论:III期肝癌患者TACE治疗中,减少化疗剂量并不缩短生存期;适当延长TACE治疗间隔时间可以延长患者的生存时间,同时降低病死危险,可能更有益于患者的生存。

Objective：To investigate the survival rate of the patients with unresectable hepatocellular carcinoma （HCC） after transcatheter hepatic arterial chemoembolization （TACE） and the hazard ratio of TACE in different dosage and different interval.Methods：The 106 cases of unresectable HCC patients were involved in this retrospective analysis. The cases were divided into,the low dose group （n=33） and traditional dose group （n=39） according to the used dose of chemotherapy in TACE,and the short interval group （6 weeks） and the long interval group （≥6 weeks） based on the intermission of TACE,respectively. Single-factor survival analysis and multi-factor Cox hazard ratio modeling were used in these groups to analyze and compare significance. Results：Single-factor survival analysis of overall survival （OS） showed that there is statistical significance between the different interval groups （P=0.020）,but no statistical significance between the different dose groups （P=0.113）. Multivariate Cox hazard ratio showed that the independent hazard factors involved in the frequency and interval of TACE as well as the liver function Child-pugh classification after TACE. Conclusions：It did not shorten live time that reducing Chemotherapeutics dose in TACE,and it could improve survival rate and degrade hazard ratio that suitably prolonging TACE interval to the unresectable HCC patients. So it may be the good choice for stage III unresectable HCC patients with low dose and long interval TACE treatment.