原发性肝癌肿瘤直径和假包膜与经动脉化学栓塞术疗效的关系

Retrospective analysis of the relationship between the diameter and pseudo-capsule of hepatocellular carcinoma and curative effect of TACE

目的 ：回顾性分析原发性肝细胞癌（hepatocellular carcinoma,HCC）直径和假包膜与经动脉化学栓塞（transarterial chemoembolization,TACE）疗效之间的关系,并分析二者与TACE术后甲胎蛋白（alpha-fetoprotein,AFP）下降程度及生存的关系。方法 ：收集172例HCC患者的临床病理资料。采用Ridit法分析肿瘤直径和假包膜与TACE术后肿瘤内碘油存积的关系,采用Spearman等级相关分析二者与TACE术后AFP下降的关系,采用Kaplan-Meier法计算累计生存率,log-rank检验不同肿瘤直径和假包膜之间生存时间的差异。结果 ：肿瘤直径〈5cm、5～10 cm及〉10 cm3组之间的碘油存积差异有统计学意义（F=49.215,P〈0.05）;假包膜完整组、不完整组及无假包膜组的碘油存积差异也有统计学意义（F=44.308,P〈0.05）。肿瘤直径与TACE术后AFP下降呈负相关（r=-0.357,P〈0.05）;假包膜完整程度与TACE术后AFP下降呈正相关（r=0.753,P〈0.05）。肿瘤直径〈5 cm、5～10 cm及〉10 cm这3组的中位生存期分别为22.9、17.4和7.2个月（P〈0.05）;假包膜完整组、不完整组及无假包膜组的中位生存期分别为24.6、18.2和10.6个月（P〈0.05）。结论 ：HCC肿瘤直径越小以及假包膜越完整,TACE术后碘油存积越好,术后AFP下降越显著,中位生存期越长,累计生存率也较高。

Objective： To retrospectively analyze the relationship between the diameter and pseudo- capsule of hepatocellular carcinoma （HCC） and the curative effect of transarterial chemoembolization （TACE）. Subsequently, the relationships of the diameter and pseudo-capsule of HCC with the descent of serum alpha-fetoprotein （AFP） level and survival time were analyzed. Methods： The clinical records of 172 patients with HCC were collected. The relationships of diameter and pseudo-capsule of tumor with lipiodol-filling in HCC tissues were analyzed by Ridit analysis. Meanwhile, the relationships of the diameter and pseudo-capsule of tumor with the descent of serum AFP level were analyzed by Spearman rank correlation. In addition, the cumulative survival rate was calculated by Kaplan-Meier method. Then, it was judged whether the survival time of the patients with HCC was significantly different according to the diameter and pseudo-capsule of tumor by log-rank analysis. Results： The amounts of lipiodol-filling in HCC tissues amon 10 cm, and different were both significant including of serum lower than AFP level o g different diameters of tumor including lower than 5 cm, 5-10 cm and more than types of pseudo-capsules including complete, incomplete and no pseudo-capsule, ly different （F = 49.21 5, P 〈 0.05; F = 44.308, P 〈 0.05）. The diameters of tumor 5 cm, 5-10 cm and more than 10 cm were negatively correlated with the descent f patients treated with TACE （r = -0.357, P 〈 0.05）. The complete pseudo-capsule of tumor was positively correlated with the descent of serum AFP levels of the patients treated with TACE （r = 0.753, P 〈 0.05）. The median survival time of the patients with different diameters of tumor including lower than 5 cm, S-10 cm and more than 10 cm were 22.9, 1 7.4 and 7.2 months, respectively （P 〈 0.05）. The median survival time of HCC with complete, incomplete and no pseudo-capsules were 24.6, 18.2 and 10.6 months, respectively （P 〈 0.05）. Conclusion： If the diameter of HCC is more smaller and the pseudo- capsule of HCC is more complete, more lipiodol would be filled in HCC tissues and serum AFP level would be decreased more obviously after TACE. In addition, the median survival time is longer and the survival rate is higher in patients with smaller diameter of tumor and more complete pseudo-capsule of HCC.