TACE序贯联合PMCT治疗原发性肝癌的预后因素分析

Prognostic factors affecting transarterial chemoembolization sequentially combined with percutaneous microwave coagulation therapy in treatment of hepatocellular carcinoma

目的:分析影响动脉化疗栓塞术(transarterial chemoemlolization,TACE)序贯联合微波凝固消融(percutaneous micro wave coagulation therapy,PMCT)治疗原发性肝癌预后的主要因素。方法:本研究收集本科收治的97例接受TACE序贯联合PMCT治疗的原发性肝癌患者。对可能影响预后的各变量进行单因素分析,再利用多因素Cox逐步回归分析影响预后的主要因素。结果:本组肝癌患者的1、2、3、5年累积生存率分别为68.2%、43.2%、28.8%、13.4%。单因素分析与预后有关的因素为肿瘤大小、临床分期(BCLC)、Child-Pugh分级、门脉癌栓、动静脉瘘、PMCT治疗次数及体力状况(ECOG评分)。Cox逐步回归多因素分析与预后有关并具有显著意义的因素为肿瘤大小、临床分期、门脉癌栓、PMCT治疗次数及体力状况。结论:适当重复PMCT治疗可以延长肝癌患者的生存期限。大肝癌、门脉癌栓为预后的危险性因素,巨块型肝癌及伴门脉主干癌栓患者的中位生存时间明显缩短。

Objective： This study aims to investigate the main prognostic factors affecting sequential transarterial chemoembolization （TACE） with percutaneous microwave coagulation therapy （PMCT）.Methods： A total of 97 hepatocellular carcinoma cases treated by sequential TACE combined with PMCT at Sun Yat-sen Memorial Hospital from January 2005 to December 2010 were selected. Univariate analysis was conducted followed by multivariate Cox regression analysis to determine the prognostic factors.Methods： A total of 97 he- patocellular carcinoma cases treated by sequential TACE combined with PMCT at Sun Yat-sen Memorial Hospital from January 2005 to December 2010 were selected. Univariate analysis was conducted followed by multivariate Cox regression analysis to determine the prognostic factors. Results： The 1-, 2-, 3-, and 5-year patient survival rates were 68.2%, 43.2%, 28.8%, and 13.4%, respectively. Univariate analysis identified the following as factors： tumor size, the Barcelona Clinic Liver Cancer （BCLC） staging, liver function grading by the Child-Pugh score, portal vein tumor thrombus, arteriovenous fistula, frequency of PMCT, and physical strength by the Eastern Cooperative Oncology Group （ECOG） standards. Prognostic factors determined by multivariate analysis using Cox stepwise regression included tumor size, BCLG staging, portal vein tumor thrombus, frequency of PMCT, and physical strength by the ECOG standards. Conclusion： Retreatment with PMCT under suitable physical conditions and liver function can prolong the survival time of liver cancer patients. Large hepatocellular carcinoma and portal vein cancerous thrombus are the risk factors affecting the prognosis. The median survival time of the patients with massive liver tumor or portal vein tumor thrombus is markedly reduced.