表柔比星经导管TACE介入治疗对晚期原发性肝癌患者生存率的影响

Effect of TACE and epirubicin on patients with advanced primary hepatocellular carcinoma

目的比较不同肝动脉化疗栓塞术(TACE)治疗模式对晚期原发性肝癌(HCC)患者生存时间和复发率的影响。方法选择2009年3月~2011年12月在我院接受TACE治疗的晚期HCC患者74例,根据首次TACE术后的情况分为肿瘤消失组(46例)和非肿瘤消失组(28例)。前者每3~4个月复查CT,有肿瘤复发迹象时再次行TACE,后者间隔1~2个月继续接受介入治疗。随访分析患者的生存时间和复发率。结果 74例患者完成研究,平均随访时间18个月(3个月~38个月)。全体患者中位生存期为17个月,第1、2、3年总体生存率分别为72.2%、38.9%和31.9%;Cox回归多因素分析表明肿瘤最大直径、肿瘤数目、肿瘤血供和Child-Pugh分级是影响患者生存的独立危险因素;肿瘤消失组第1、2、3年复发率分别为56.5%、76.1%和80.4%,经Cox回归多因素分析,只有肿瘤血供是影响肿瘤复发的独立危险因素。肿瘤消失组中位生存期为18个月,第1、2、3年生存率分别为73.9%、41.3%和34.8%;非肿瘤消失组中位生存期为16个月,第1、2、3年生存率分别为69.2%、34.6%和26.9%,两组生存情况差异无统计学意义(χ2=0.732,P=0.392)。结论多次进行TACE治疗并不能提高HCC患者的生存时间,应根据术后影像学资料确定治疗次数和间隔,同时肿瘤最大直径、肿瘤数目、肿瘤血供和Child-Pugh分级影响HCC预后,而肿瘤血供与TCAE术后复发呈负相关。

Objective To compare survival time and recurrence rate of different transcatheter arterial chemoembolization（TACE） modalities for advanced hepatocellular carcinoma（HCC）. Methods From March 2009 to December 2011,74 patients with advanced HCC administered TACE in our hospital. They were divided into tumor disappeared group（n=46） and non-tumor disappeared group（n=28） according to if tumor disappeared after the first TACE. The former group received CT inspection at the intervals of 3 to 4 months and TACE administered again when signs of tumor recurrence appeared. The latter group continued to receive TACE after 1 to 2 months interval. Survival time and recurrence rate were analyzed after intervention. Results 74 patients completed this study and the average follow-up time was 18months（3 months^38 months）. The median survival time of all patients was 17 months and the survival rates of 1, 2,3-year were 72.2%, 38.9% and 31.9%. Cox regression analysis showed that tumor size, number of tumors, tumor blood supply and Child-Pugh classification were independent risk factors affecting survival. The1, 2, 3-years recurrence rates of tumor disappeared group were 56.5%, 76.1% and 80.4%. Only tumor blood supply was risk factor affected tumor recurrence independently by Cox regression analysis. The median survival time of tumor disappeared group was18 months and the 1, 2, 3-year survival rates were 73.9%, 41.3% and 34.8%. The median survival time of non-tumor disappeared group was 16 months and 1, 2, 3-year survival rates were 69.2%, 34.6% and 26.9%. There was no significant difference between two groups（χ2=0.732, P=0.392）. Conclusion Repeated TACE could not improve survival time in patients with HCC. Frequency and interval should base on radiological data after first TACE. The maximum tumor diameter, number of tumors, tumor blood supply and the Child-Pugh classification affect HCC prognosis, while tumors blood supply and TCAE recurrence correlate negatively.