原发性肝癌四种治疗策略的成本效果比较

Cost-effectiveness comparison of four treatment strategies for primary liver cancer

目的 比较原发性肝癌患者四种治疗策略的预后和费用,为患者选择治疗方案提供参考。方法 回顾性分析2014年1月1日—2018年12月31日在首都医科大学附属北京佑安医院首次确诊的644例原发性肝癌患者的临床资料,按治疗方式的不同分为肝切除(LR)、经动脉化疗栓塞(TACE)、TACE联合射频消融(RFA)和对症治疗四组。比较四种治疗方案的生存率和预后影响危险因素,并进行成本效果分析。结果 随访至2020年12月31日,TACE联合RFA组1~5年的总生存率明显优于其他三组(P<0.05)(LR组:58.33%、27.08%、14.58%、4.17%、2.08%,TACE组:71.23%、53.42%、35.62%、24.66%、12.33%,TACE联合RFA组:75.30%、58.43%、45.48%、29.22%、17.17%,对症治疗组:28.89%、15.56%、0.00%、0.00%、0.00%)。其中治疗措施、BCLC分期、腹水和肝性脑病是影响总生存率的独立预后因素。四组的均次治疗费用分别为:LR组(72 201.00±113 067.69)元、TACE组(37 302.35±34 759.82)元、TACE+RFA组(41 163.46±36 920.18)元和对症治疗组(35 968.44±25 546.05)元,差异有统计学意义(P<0.001)。以四种治疗方案的5年生存率作为效果进行成本-效果分析。因为对症治疗组没有患者存活至5年,所以其余三个治疗组的成本效果比从高到低依次为:LR组34 712.02;TACE组3 025.33;TACE+RFA组2 397.41,差异有统计学意义(P<0.05)。结论 与LR、TACE和对症治疗相比,TACE和RFA联合应用在提高生存率和降低成本方面更具优势。

Objective To compare the prognosis and cost of four treatment strategies for patients with primary liver cancer(PLC), so as to provide reference for patients to select treatment schemes. Methods The clinical data of 644 patients with PLC primarily diagnosed in Beijing You’an Hospital Affiliated to Capital Medical University from January 1, 2014 to December 31, 2018 were retrospectively analyzed. According to different treatment methods, they were divided into four groups: Hepatectomy(LR) group, transcatheter arterial chemoembolization(TACE) group, TACE combined with radiofrequency ablation(RFA) group, and symptomatic treatment group. The survival rate and prognostic risk factors of the four treatment schemes were compared, and the cost-effectiveness analysis was carried out. Results The 1-to 5-year overall survival rates of TACE combined with RFA group were significantly better than that of the other three groups(P<0.05)(LR group: 58.33%, 27.08%, 14.58%, 4.17%, 2.08%;TACE group: 71.23 %, 53.42%, 35.62%, 24.66%, 12.33%;TACE combined with RFA group: 75.30%, 58.43%, 45.48%, 29.22%, 17.17%;symptomatic treatment group: 28.89%, 15.56%, 0.00%, 0.00%, 0.00%, respectively). Treatment, BCLC stage, ascites and hepatic encephalopathy were independent prognostic factors affecting the overall survival rate. The average treatment costs of each time in the four groups were ￥72201.00±113067.69 in LR group, ￥37302.35±34759.82 in TACE group, ￥41163.46±36920.18 in TACE+RFA group, and ￥35968.44±25546.05 in symptomatic treatment group, which had no statistically significant diference(P<0.001). The 5-year survival rate of four treatment schemes was used as the effectiveness for cost-effectiveness analysis. Because no patients in the symptomatic treatment group survived to 5 years, the cost-effectiveness ratios of the other three treatment groups were as follows: LR group: 34712.02;TACE group: 3025.33;TACE+RFA group: 2397.41, and the difference was statistically significant(P<0.05). Conclusion In conclusion, the combination of TACE and RFA treatment had more advantages than LR, TACE and symptomatic treatments for PLC in improving survival rate and reducing costs.