不同治疗方案对晚期肝细胞性肝癌预后的影响及因素分析

Effect and factor analysis of different treatment strategies on prognosis of advanced hepatocellular carcinoma patients

目的:研究单纯和联合治疗方案对晚期肝细胞肝癌(HCC)预后的影响,分析影响预后的主要因素。方法:回顾性分析2014年我院收治的133例晚期HCC患者,统计24项预后相关数据,采用Cox单因素和多因素回归模型分析预后影响因素。统计患者接受的所有治疗方式,并分为3种治疗方案:(1)保守治疗58例;(2)单纯肝动脉化疗栓塞术(TACE)治疗58例;(3)联合治疗17例:TACE联合索拉菲尼或者TACE联合立体定向放疗(SBRT)。Kaplan-Meier法绘制生存曲线,并使用Log-rank检验比较患者生存期差异。结果:133例患者总体中位生存期为7.6个月,其中6个月、1年、2年的生存率分别为57%、30%、12%。多因素分析证明Child-Pugh分级、门静脉癌栓类型、肝外转移类型以及甲胎蛋白水平为影响预后的独立因素。治疗方案上,TACE联合索拉菲尼与TACE联合SBRT之间无明显差异,但均明显优于单纯TACE治疗,且单纯TACE治疗明显优于保守治疗。结论:Child-Pugh分级、门静脉癌栓类型、肝外转移类型和甲胎蛋白水平是影响晚期HCC预后的独立因素。TACE联合索拉菲尼或TACE联合SBRT的预后均优于单纯TACE治疗,单纯TACE治疗优于保守治疗。

Objective： To analyze different treatnmnt strategies and prognostic factors for hepatocellular carcinoma （HCC） patients with an advanced stage. Methods： A total of 133 consecutive HCC patients with an advanced stage were evaluated retrospectively. Twenty-four prognostic factors were counted and then evaluated using univariate and muhivariate Cox regression analysis.All treatment modalities of every patient during the follow-up period were collected earefully, and were separated into three strategies： （1） conservative therapy; （2） transarterial ehemoembolization （TACE） monotherapy; （3） combined therapy, including TACE combined with sorafenib therapy and TACE combined with radiation therapy. The Kaplan-Meier method, with differences in survival estimated using the Log-rank test, was used to compare different prognoses. Results： The median survival time of all 133 advanced HCC patients was 7.6 months, and the survival rates at 6 months, 1 year and 2 years were 57% , 30% and 12% , respectively. Multivariate analysis identified that Child-Pugh class,type of portal vein tumor thrombus （PVTT）,type of extrahepatie metastasis （EHM） and level of α-fetoprotein （AFP） were independent predictors of survival. For the treatment strategy, a combined therapy for both intrahepatie and extrahepatie tumors was superior to TACE monotherapy for advanced HCC patients. And TACE monotherapy was better than conservative treatment obviously. Conclusions： Child-Pugh class,type of PVTT,type of EHM and AFP level are demonstrated to be independent predictors of survival in HCC patients with an advanced stage. For advanced HCC patients in our study,a combined therapy is better than TACE monotherapy,and TACE monotherapy is better than conservative treatment.