手术与经肝动脉导管化疗栓塞治疗中晚期肝癌生存率的比较

A Comparison of Survival in Hepatocellular Carcinoma Patients with BLCC Stage B and C between Hepatic Resection and Transarterial Chemoembolization

目的比较肝细胞性肝癌(HCC)巴塞罗那肝癌临床分期(BCLC)B期、C期患者行肝切除术及经肝动脉导管化疗栓塞(TACE)治疗的疗效。方法 BCLC B期、Child-pugh A级HCC患者191例,其中行肝切除治疗105例,TACE治疗86例;BCLC C期、Child-Pugh A～B级合并门静脉癌栓患者73例,其中肝切除治疗30例,TACE治疗43例。结果 BCLC B期191例患者中,肝切除术组1、3、5年生存率分别为67.10%、49.20%、38.12%,中位生存期为38.3个月;TACE组生存率分别为50.13%、22.11%、8.06%,中位生存期为16.0个月;BCLC C期73例患者中,肝切除术组1、2、3年生存率分别为40.00%、23.30%、13.30%,中位生存期为24.0个月,TACE组1、2、3年生存率分别为20.10%、0.00%、0.00%,中位生存期为10.0个月。BCLC B期、BCLC C期肝切除术组的平均生存时间均长于TACE组(P<0.05),生存率均高于TACE组(P<0.05)。结论在严格选择病人的情况下,肝切除术较TACE治疗更能提高BCLC B期、C期HCC患者的生存率,延长生存时间。

Objective To observe the efficacy of hepatic resection and transarterial chemoembolization（TACE） for hepatocellular carcinoma（HCC） patients with Barcelona Clinic Liver Cancer（BCLC） stage B and C. Methods A total of 264 HCC patients,involving 191 patients with BCLC stage B, Chlid-pugh A and 73 patients with BCLC stage C, Chlid-pugh A or B ,were included in this retrospective study. Of patients with BCLC stage B, 105 patients underwent hepatic resection and 86 patients underwent TACE. Of patients with BCLC stage C, 30 patients underwent hepatic resection and 43 patients underwent TACE. Results In the group of BCLC stage B, the 1, 3-, 5-year survival in hepatic resection group were 67.10% ,49.20% ,and 38.12% compared with 50. 13% ,22. 11% ,and 8.06% in TACE group. The mean survival time was 38.3 months in the hepatic resection group compared with 16.0 months in the TACE group. In the group of BCLC stage C,the 1-,3-,5-year survival in hepatic resection group we^e 40.00% ,23.3% ,and 13.30% compared with 20. 10% ,0.00% ,and 0.00% in TACE group. The mean survival time was 24.0 months in the hepatic resection group compared with 10.0 months in the TACE group. The average survival time of patients with BCLC stage B or C in the hepatic resection group was longer than that in the TACE group（P 〈0.051）,and the survival in the hepatic resection group was higher than that in TACE group （ P 〈 0.05 ）. Conclusion For HCC patients with BCLC stage B or C ,the overall survival time and the survival of the patients who have undergone hepatic resection are superior to those of the patients undergone TACE.