中医药对原发性肝癌微波消融后复发转移影响的前瞻性队列研究

A Cohort Study of Traditional Chinese Medicine(TCM) on Primary Liver Cancer in the Recurrence and Metastasis after Microwave Ablation

目的:本文主要探讨了中医药对原发性肝癌微波消融后患者复发转移的影响。方法:采用前瞻性队列研究的方法,以消融时间在2011年11月1日-2012年5月31日间的原发性肝癌微波消融治疗后患者为研究对象,以服用中药为暴露因素,根据服用中药时间分高暴露、低暴露和无暴露3个队列。结果:共入组患者180例(高暴露组65例、低暴露组56例、无暴露组59例),三组治疗后3个月主症评分均较治疗前明显降低;高暴露组下降分值更多,但与其它两组比较无显著差异。低暴露组、高暴露组治疗后3个月NK样T细胞与无暴露组相比有显著差异。三组患者2年的复发转移率分别为68.6%、57.4%、33.3%,高暴露组复发转移率明显低于无暴露组。Cox多因素回归分析提示暴露因素为保护因素。结论:对于微波消融术后的原发性肝癌患者,联合中医药治疗可以减少消融后的复发转移。

This study aimed to investigate the efficacy of TCM on the recurrence and metastasis of primary liver cancer（PLC） after percutaneous microwave ablation（PMWA）. From November 2011 to May 2013, patients with PLC were voluntarily received PMWA treatment, and then TCM treatment based on syndrome differentiation with traditional patent medicine. In regard to the start date of TCM treatment, the patients were classified into the high exposure group, the low exposure group and the non-exposure group. In this study, 180 patients were recruited in aggregate. The high exposure, the low exposure and the non-exposure group included 65, 56 and 59 patients, respectively. The figure of nature killer T cell（NKT） count of the high exposure group was significantly increased after TCM treatment. While the number of NKT cell count of the low- and high-exposure groups were augmented significantly three months after TCM treatment compared with the non-exposure group. The 2-year recurrence and metastasis of the three groups were 68.6%, 57.4% and 33.3% respectively. The recurrence rate of the high-exposure group was significantly decreased after TCM treatment compared with the non-exposure group. Cox multivariate regression analysis showed that TCM treatment was a protective factor in recurrence and metastasis. In conclusion, TCM treatment may improve the recurrence and metastasis of PLC after PMWA.