中医诊疗方案联合TACE治疗川南地区乙肝相关性中晚期原发性肝癌的回顾性研究

Retrospective Study of Traditional Chinese Medicine Diagnosis and Treatment Plan Combined with TACE in the Treatment of Hepatitis B-related Advanced Primary Liver Cancer in Southern Sichuan

目的研究中医诊疗方案联合TACE(经肝动脉栓塞化疗术)治疗川南地区乙肝相关性中晚期原发性肝癌(HBV-PLC)的疗效、临床特征以及影响预后的因素。方法纳入77例首次确诊为HBV-PLC并行TACE治疗且口服中药的病例,按照我科《原发性肝癌诊疗方案》进行辨证论治,分析其生存状态及临床特征,建立COX风险比例回归模型分析危险因素。结果川南地区中晚期HBV-PLC以男性居多,以50~60岁发病率最高,多数患者合并肝硬化,病灶多位于肝右叶,以结节型居多。COX风险比例模型提示男性、门静脉癌栓、肿瘤为肝内多发、BCLC C期、HbeAg阳性、HBV-DNA>105copy/mL是影响其预后的危险因素。病例总中位生存期为13月(95%CI:7.343~18.657),以肝郁脾虚证型患者的累积生存率优于其他证型。结论川南地区中晚期HBV-PLC主张综合治疗,中医方面,从肝脾论治在延长患者生存期方面可能获益。

Objective To study the curative effect of traditional Chinese medicine diagnosis and treatment scheme combined with TACE in the treatment of HBV-related advanced liver cancer(HBV-PLC)in southern Sichuan.Methods 77 cases were diagnosed advanced HBV-PLC the first time with TACE therapy and TCM.The survival status and basic clinical characteristics were analyzed,and a COX risk ratio regression model was established to analyze the risk factors.Results The incidence of HBV-PLC in the advanced stages was mostly male,50-60 years old,cirrhosis,in the right lobe of the liver and nodular.A COX risk ratio model suggested those men,portal vein tumor thrombi,multiple tumors,BCLC C,HbeAg-positive and HBV-DNA>105copy/ml is risk factors.The OS was 13 months(95%CI:7.343,18.657),and the cumulative survival rate who is liver depression and spleen deficiency was superior.Conclusion The treatment of advanced HBV-PLC in southern Sichuan is comprehensive.Liver and spleen theory may benefit in the survival.