【摘要】 目的:分析原发性肝癌(HCC)患者根治切除术后联合应用肝动脉化疗栓塞术(TACE)和药物化疗的生存情况。方法:选取在宁波市第二医院随访5年以上的HCC术后患者143例,按术后治疗方法不同分为介入组(术后予以TACE)、化疗组(术后予以FOLPOX4化疗方案)及综合组(术后予以TACE+FOLPOX4化疗方案)。采用多因素Cox回归模型分析HCC患者术后预后的影响因素(包括性别、年龄、肝炎病史、肿瘤直径、术后肝功能、术后甲胎蛋白水平、术后Karnofsky performance status评分及术后治疗方案),并绘制各组生存曲线,计算1、2、3年累积生存率,采用Kaplan-Meier方法进行比较。结果:术后甲胎蛋白水平与患者生存时间呈负相关,为独立危险因素,回归系数为0.01,相对危险度为1.00;术后进一步治疗能提高HCC术后患者的生存时间,为保护因素,其中采取综合方案的回归系数为-2.37,相对危险度为0.07,影响生存时间的权重比高于另外两组,而介入组的权重比高于化疗组。术后1、2、3年累计生存率综合组分别为78.35%、69.16%、24.43%,介入组分别为76.87%、62.48%、24.72%,化疗组分别为62.23%、43.22%、19.54%。结论:术后甲胎蛋白水平与HCC患者术后生存质量存在负相关,术后甲胎蛋白水平监测可为手术效果及预后判断提供参考。TACE运用于HCC术后能有效降低患者病死率,联合药物化疗能有效延长HCC患者术后生存时间。更多还原

【Abstract】 Objective:To evaluate the survival of hepatocellular carcinoma(HCC)patients received prophylactic use of transcatheter arterial chemoembolization(TACE)after radical resection.Methods;One hundred and forty-three cases of HCC from Ningbo No.2 Hospital were divided into intervention prevention group,chemotherapy prevention group and comprehensive prevention group according to different methods of HCC prevention.All patients were followed-up for more than 5 years after TACE,chemotherapy(FOLPOX4) or TACE + FOLPOX4.Cox regression model of multiple factors analysis was used for analyzing impact factors on HCC prognosis.Survival rate was compared with Kaplan-meier method.Results:Alpha-fetoprotein(AFP) was negatively correlated with the survival time of patients,as an independent risk factor with the regression coefficient of 0.01 and the relative risk of 1.00.Prevention of postoperative increased survival time of patients with HCC,which was a protective factor.The regression coefficient for comprehensive prevention was- 2.37 and the relative risk was 0.07,the weight of comprehensive prevention on lifetime was higher than that of other two prevention methods,followed by TACE prevention group.One-year,2-year,3-year cumulative survival rates in comprehensive prevention group were 78.35%,69.16%,24.43%,that in TACE prevention group were 76.87%,62.48%,24.72%,and that in chemotherapy prevention group were 62.23%,43.22%,19.54%,respectively.Conclusion;AFP was negative correlation with the survival time of postoperative HCC patients,monitored which of postoperative HCC patients can provide a reference for effect and prognosis of surgery.Application of TACE in HCC patients with postoperative effective in reducing mortality,which prolong the survival time of HCC patients might be extended further by combined chemotherapy based on its own advantages and disadvantages.更多还原