TACE改善伴有肝外转移肝细胞癌患者预后

Transarterial chemoembolization improves the prognosis of patient with hepatocellular carcinoma accompanied by hepatic metastasis

目的:探讨肝动脉化疗栓塞(TACE)对伴有肝外转移的肝细胞癌患者预后的影响。方法:回顾性分析本院2007年1月至2009年1月72例此类患者的临床资料,Kaplan-Meier法计算生存率,Log-rank检验和Cox回归模型分别进行预后单、多因素分析。结果:72例患者中Child A-B级63例,接受TACE或肝动脉灌注化疗(TACI),部分患者联合全身化疗(SC)或仅行保守治疗。最长随访时间35个月,死亡56例(88.9%)。患者1-,2年的总生存率分别为19.5%,7.4%。T1-2期(20例)行TACE/TACI+SC,TACE/TACI,SC和CM的患者中位生存时间分别为23,12,5,3个月,T3期(43例)患者对应数据为7,5,3,2个月。TACE/TACI单独使用或联合SC的治疗效果均显著优于CM(P<0.05)。Cox多因素分析发现高UICC/AJCC T分期,大血管侵犯,淋巴结或肺转移,未接受TACE/TACI治疗是影响患者预后的独立危险因素。结论:TACE/TACI能改善肝功能良好,伴肝外转移的HCC患者的预后,延长其生存时间。

[ Objective ] To explore the influence of transarterial chemoembolizafion （TACE） in patients with extrahepatie meta- simsis at initial diagnosis of hepatocellular carcinoma （HCC）. [Method] Seventy two patients with extmhepatic metasitasis at initial diagnosis of HCC in our department from January 21）07 and January 2009 were enrolled for this retrospective analysis. Pa- tients were administrated TACE/TACI alone or plus systematic chemotherapy （SC） or only treated by conservative management （CM）. SPSS13.0 software was used for statistical analysis. The Kaplan- Meier method was used to evaluate the survival rates. Log - rank test and Cox regression model were used to analysis the single and multi - factors for the prognosis. [ Result] There were 63 patients with preserved liver function （Child A - B）. The longest time of follow - up was 35 months, with a mortality of 88.9%. The 1- and2- year overall survival rates were 19.5% and 7.4%, respectively. The median time of survival in patients （n=20） with T1 - 2 stage HCC was 23- ,12- ,5- and 3 - month in TACE/TACI ＋ SC, TACE/TACI, SC and CM group respectively, while the corresponding data for patients （n = 43） with T3 stage HCC was 7 -, 5 -, 3 -, 2 - month respectively. TACE/TACI alone or plus SC improved prognosis significantly than CM （ P 〈 0.05）. Multivariate Cox regression analysis showed that the high UICC/AJCC T stage, macro- vascular invasive, lymph node and lung metastasis and untreated by TACE/TACI were independent prognostic factors. [ Conclusion]TACE/TACI can significantly improve the prog- nosis of metastatic HCC patients with conserved liver function.