中医药联合TACE对中晚期肝癌患者生存期影响的回顾性队列研究

Retrospective cohort study on the effect of comprehensive treatment of Chinese medicine on the survival of patients with advanced hepatocellular carcinoma

目的分析中医药联合肝动脉化疗栓塞(TACE)对原发性肝癌巴塞罗那(BCLC)分期为C期的患者生存期的影响。方法:本研究采用回顾性队列研究方法,共纳入157例在2013. 8. 31～2017. 8. 31期间收治的进行TACE治疗的BCLC分期为C期的原发性肝癌患者,将中医药治疗作为一种暴露因素,按照肝癌患者接受中医药治疗的暴露程度不同划分为中医药高暴露组、中医药中暴露组、中医药低暴露组、中医药无暴露组,主要观察指标为中位生存期(OS)。结果 157例肝癌患者中,高暴露组34例、暴露组56例、低暴露队组35例、无暴露队列32例。4组患者在性别、年龄、甲胎蛋白(AFP)值、体力状态ECOG评分、肝功能Child分级、基础肝病类型方面差异无统计学意义(P> 0. 05),具有可比性。中药高暴露组0. 5、1、2年生存率分别为100%、41. 17%、8. 80%,中药中暴露组0. 5、1、2年生存率分别为60. 70%、17. 10%、1. 78%,中药低暴露组0. 5、1、2年生存率分别为45. 7%、10. 70%、0%,中药无暴露组0. 5、1、2年生存率分别为34. 37%、6. 25%、0%。中医药高、中、低暴露组及无暴露组的OS分别为为14. 412、10. 855、8. 984和7. 108个月。各组间中位生存时间比较均具有统计学意义(P <0. 05)。经单因素及COX多因素回归分析,在接受TACE治疗的BCLC分期为C期的157例原发性肝癌患者中,ECOG评分、肝功能Child分级、中医药治疗是其预后的保护性因素。结论对于BCLC分期为C期的原发性肝癌患者,中医药联合TACE治疗可提高患者的生存率和生存时间。

Objective This study analyzes the effect of traditional Chinese medicine （TCM）combined with transcatheter arterial chemoembolization （TACE） on the survival time of patients with stage C of primary liver cancer in Barcelona （BCLC） standard. Methods In this study, a retrospective cohort study was carried out in 157 primary liver cancer patients from August 31,2013 to August 31,2017. All the patients were divided into stage C and received TACE treatment. Traditional Chinese medicine is treated as an exposure factor,the patients were -i-ided int,） high exposure group of TCM, moderate exposure group of TCM, low exposure group of TCM and unexposure group of TCM according to the degree of exposure. The main index of observation was median survival （OS）. Re- sult Among the 157 patients with liver cancer, 34 cases were in high exposure group, 56 cases were in moderate exposure group, 35 cases were in low exposure group and 32 cases were in unexposure group. There were no significant differences between the 4 groups in sex, age, AFP index, ECOG score, Child classification and basic liver disease （ P 〉 0.05）. The survival rates of six months, one year,and two years were 100%, gl. 17% and 8.80% respectively in the high exposure group. The survival rates of six months, one year, and two years were 60.70%, 17.10% and 1.78% respectively in the moderate exposure group. The survival rates of six months, one year,and two years were 45.7 % ,10.70 % and 0% respectively in the low exposure group. The survival rates of six months, one year,and two years were 34. 37 % ,6.25% and 0% respectively in the unexposure group. The OS was 14. 412 months, 10. 855 months, 8. 984 months and 7. 108 months in high exposure, moderate exposure, low exposure and unexposure groups respectively. Comparison of median survival time among the four groups was statistically significant （P 〈 0.05）. After single factor and multivariate COX regression analysis, the ECOG score, liver function and TCM were the protective factors for these patients. Conclusion For patients with stage C of primary liver cancer in BCLC standard, TCM combined with TACE treatment could improve the survival rate and survival time of patients.