外科手术联合肝动脉化疗栓塞对原发性肝癌患者生存状况影响的研究

Survival of patients with primary liver cancer after combined treatment of surgery and hepatic artery embolism chemotherapy

目的研究外科手术联合肝动脉化疗栓塞（TACE）对原发性肝癌患者生存状况影响。方法选取2013年9月至2014年9月接受外科手术联合TACE治疗的原发性肝癌患者80例。将术后2个月内影像学检查未发现病灶行预防性TACE者为预防组（32例），按期随访直至复发再行TACE者为对照组（48例）。统计患者的生存率和生存时间，采用SPSS17．0软件，1—3年生存率用χ^2检验，应用log—rank检验及Cox模型分析影响患者生存状况的因素，P〈0．05具有统计学意义。结果原发性肝癌预防组患者术后中位生存期38个月，生存率：1年84．38％，2年56．25％，3年53．13％；对照组术后中位生存期22个月，生存率：1年64．58％，2年43．75％，3年29．17％，差异均有统计学意义（χ^2=4．082、4．378、3．991、4．135，P〈0．05）。应用log—rank筛选出影响原发性肝癌患者术后生存状况的相关因素：肿瘤直径、腹水、有无门脉癌栓、凝血酶原时间和是否行预防性TACE。多因素分析显示，肿瘤直径是影响原发性肝癌患者术后生存状况的重要因素。结论外科手术联合肝动脉化疗栓塞可明显提高原发性肝癌患者的生存率，此外肿瘤直径也是影响其预后的独立相关因素。

Objective To investigate the survival status of patients with primary liver cancer who received combined treatment of surgery and hepatic artery embolism chemotherapy （TACE）. Methods Eighty patients with primary liver cancer underwent combined surgical resection and TACE treatment in our hospital from September 2013 to September 2014. Thirty-two patients without lesions confirmed by imaging examination received preventive TACE treatment 2 months after operation and were included in a prevention group, whereas 48 patients who didn＇ t receive TACE until the recurrence of liver cancer were enrolled in a control group. The survival rate of the patients was analyzed by using the SPSS17.0 software; the 1 -3 years survival rates were analyzed by the Chi-square test, and risk factors of survival were analyzed by the log-rank test and Cox model. A P value 〈 0.05 was considered statistically significant. Results In the prevention group, the median survival of patients was 38 months, with a 1-year survival rate of 84.38%, a 2-year survival rate of 56.25% , and a 3-year survival rate of 53.13%. In the control group, the median survival of patients was 22 months, with a 1-year survival rate of 64.58% , a 2-year survival rate of 43.75%, and a 3-year survival rate of 29.17%. There was significant difference between the 2 groups （X2 =4. 082, 4. 378, 3. 991, 4. 135 respectively, P 〈 0. 05）. The log-rank test was used to investigate the risk factors of postoperative survival, including tumor diameter, ascites, tumor emboli of the portal vein, prothrombin time, and preventive TACE or not. Multipal factor analysis showed that tumor diameter was the important factor influencing the postoperative mortality of patients with primary liver cancer. Conclusions The survival rate of patients with primary liver cancer could be improved after combined use of surgery and TACE. Tumor diameter is confirmed as an independent risk factor of prognosis.