倾向性评分匹配法评估手术联合术中放疗在肝癌治疗中的安全性及有效性

Safety and Efficacy of Hepatectomy Combined Intraoperative Electron Radiotherapy for Liver Cancer:a Propensity Score Matching Analysis

目的倾向性评分匹配法(Propensity Score Matching,PSM)评估手术联合术中放疗治疗原发性肝癌的安全性及疗效。方法收集2009~2012年于笔者医院肝胆外科行手术联合术中放疗(intraoperative electron radiotherapy,IOERT)的18例原发性肝癌(primary liver cancer,PLC)患者的临床资料,其中16例经术后病理证实为肝细胞癌(hepatocellular carcinoma,HCC),2例为肝内胆管细胞癌(intrahepatic cholangiocarcinomas,ICC);采用倾向性评分匹配方法,按照1∶2比例从同期行单纯手术的原发性肝癌患者中筛选出36例做为对照组(32例HCC,4例ICC),比较两组患者术中及术后并发症发生情况及HCC患者术后早期(2年内)复发率。结果所有患者均获随访,随访率100%。两组患者术中出血量、术后3个月内肝功能、凝血功能、血常规及术后住院天数的比较,差异均无统计学意义(P>0.05),仅在手术时长方面,联合IOERT组长于单纯手术组(P=0.000)。此外,联合IOERT组术后出现1例急性肾功能衰竭和1例胸腔积液,单纯手术组术后出现1例肝创面出血。在疗效方面,以两组48例HCC患者为研究对象,联合IOERT组的HCC患者为16例,其中6例在2年内复发,早期复发率为37.5%;单纯手术组的HCC患者为32例,20例在2年内复发,早期复发率为62.5%,两组早期复发率的比较,差异无统计学意义(P=0.101)。结论手术联合术中放疗治疗原发性肝癌安全可行,尽管联合放疗组早期复发率低于单纯手术组,但差异并无统计学意义。

Objective To explore the safety and efficacy of patients with PLC undergoing hepatectomy combined IOERT after propensity score matching. Methods From 2009 to 2012,The clinical data of 18 patients with primary liver cancer undergoing hepatectomy combined IOERT were analyzed, including 16 cases of HCC and 2 cases of ICC confirmed by postoperative pathology. By using the Propensity score matching model（1：2）, 36 patients were screened from patients receiving hepatectomy alone during the same period as control group （32 cases of HCC, 4 cases of ICC）.To compare intraoperative and postoperative complications,and early postoperative recurrence（less than 2 years） of HCC patients between two groups. All patients were followed up regularly. Results All the patients were followed up, and the follow-up rate was 100%. No significant differences were observed in intraoperative bleeding volume, liver function, coagulation function, blood routine examination and postoperative hospital stay between two groups.However, the operative time between two groups was statistically difference（P=0.000）. 2 patients of combination treatment group developed postoperative complications：1 acute renal failure and 1 hydrothorax. 1 patient of control group developed liver wound bleeding.6 HCC cases of combined IOERT group replapsed within 2 years, with the early recurrence rate of 37.5%,while 20 HCC cases of control group replapsed, with the early recurrence rate of 62.5%. There were no statistically significant differences between two groups（P=0.101）. Conlusion Hepatectomy combined IOERT for patients with PLC was safe. The early recurrence rate were no statistical difference between two groups.