【摘要】 目的探讨肝切除术后辅助性经肝动脉化疗栓塞术(TACE)对肝细胞癌(HCC)患者生存的影响,并分析影响其预后的相关因素。方法回顾性分析2007年1月-2012年12月武汉大学人民医院收治的215例HCC患者的临床资料。根据肝切除术后是否联合TACE治疗分为单纯组(95例)及联合组(120例)。单纯组采用单纯肝切除术治疗,联合组先行肝切除术,术后1个月给予TACE治疗。记录2组患者一般情况、治疗情况及相关临床指标,比较2组患者术后1、3、5年生存率及无瘤生存率。计量资料组间比较采用独立样本t检验,计数资料组间比较使用χ2检验。组间生存比较采用Kaplan-Meier生存分析,采用单因素分析及Cox多因素回归分析肝切除术后预后的影响因素。结果联合组术后1、3、5年生存率分别为96.5%、67.0%、51.0%,中位生存期为51个月;单纯组分别为84.0%、49.5%、36.5%,中位生存时间为39个月,2组生存率差异有统计学意义(χ2=5.540,P=0.018)。联合组术后1、3、5年无瘤生存率均分别为91.7%、62.5%、37.5%,单纯组分别为84.0%、42.1%、26.3%,差异有统计学意义(χ2=4.942,P=0.027)。术前AFP≥400μg/L、TNM分期Ⅲ期、肿瘤多发、肿瘤直径>5 cm、HBs Ag阳性及发生血管侵犯是影响患者肝癌切除术后预后的独立危险因素,而TACE则是患者长期生存的保护因素。结论肝切除术后行辅助性TACE治疗可明显提高HCC患者的生存率及无瘤生存率,对提高手术疗效具有重要意义。更多还原

【Abstract】 Objective To investigate the effect of postoperative adjuvant transarterial chemoembolization( TACE) on the survival of patients with hepatocellular carcinoma( HCC),as well as influencing factors for prognosis. Methods A retrospective analysis was performed for the clinical data of 215 HCC patients who were admitted to Renmin Hospital of Wuhan University from January 2007 to December 2012. According to whether TACE was given after hepatectomy,these patients were divided into single group with 95 patients and combination group with120 patients. A comparative analysis was performed for the two groups. The patients in the single group were given hepatectomy alone,and those in the combination group were given hepatectomy followed by TACE at one month after surgery. General status,treatment condition,and related clinical indices were recorded for both groups,and the two groups were compared in terms of the 1-,3-,and 5-year survival rates and disease-free survival rates after surgery. The independent samples t-test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier method was used for comparison of survival rates between groups,and univariate analysis and Cox multivariate regression analysis were used to investigate the influencing factors for prognosis after hepatectomy. Results In the combination group,the 1-,3-,and 5-year survival rates were 96. 5%,67. 0%,and 51. 0%,respectively,with a median survival time of 51 months; in the single group,the 1-,3-,and 5-year survival rates were 84. 0%,49. 5%,and 36. 5%,respectively,with a median survival time of 39 months; there was a significant difference in survival rates between the two groups( χ2= 5. 540,P = 0. 018). The 1-,3-,and 5-year disease-free survival rates were 91. 7%,62. 5%,and 37. 5%,respectively,in the combination group and 84. 0%,42. 1%,and 26. 3%,respectively,in the single group,and there was a significant difference between the two groups( χ2= 4. 942,P = 0. 027). Preoperative alpha-fetoprotein > 400 μg/L,TNM stage III,multiple tumors,tumor diameter > 5 cm,positive HBs Ag,and vascular invasion were independent prognostic factors in patients after hepatectomy,while TACE was a protective factor for long-term survival of these patients. Conclusion Adjuvant TACE after hepatectomy can significantly improve the survival rate and disease-free survival rate of HCC patients and has great significance in improving surgical outcome.更多还原