【摘要】 目的 探讨经动脉载药微球化疗栓塞（DEB-TACE）治疗大肝癌效果的影响因素。方法 回顾性分析2016年12月至2020年5月郑州大学第一附属医院接受DEB-TACE治疗的228例大肝癌患者临床资料。观察6、12个月患者客观缓解率（ORR）、总生存期（OS）和1、2年的生存率。采用Cox回归模型分析DEB-TACE治疗患者预后的影响因素。结果 228例患者DEB-TACE术后平均随访36.9个月，最长62个月。首次治疗后6个月与12个月的ORR为55%和43%。患者整体中位OS为11.9个月（95%CI:8.6～14.8）。患者1年的生存率单发与多发（54.1%比36.9%）、单叶分布与双叶分布（54.1%比36.9%）、有包膜与无包膜（56.5%比47.1%）、肿瘤体积≤肝脏体积50%与>50%(53.3%比27.5%),2年的生存率单发与多发（30.9%比23.1%）、单叶分布与双叶分布（31.4%比17.1%）、有包膜与无包膜（43.5%比24.5%）、肿瘤体积≤肝脏体积50%与>50%(32.0%比5.5%)，差异均有统计学意义（均P<0.05）。单因素分析显示，肿瘤数目、肿瘤包膜、肿瘤分布、肿瘤占肝脏体积百分比、Child-Pugh分级、门脉癌栓是治疗后患者生存的影响因素；多因素分析显示，肿瘤体积>肝脏体积50%、合并门脉癌栓、肿瘤包膜是治疗后患者生存的影响因素。结论 DEB-TACE治疗大肝癌安全、有效；肿瘤占肝脏体积>50%、门脉癌栓是DEB-TACE治疗大肝癌预后的独立危险因素，而肿瘤包膜是预后的保护因素。更多还原

【Abstract】 Objective To investigate the factors that influence the effect of drug-eluting beads transarterial chemoembolization(DEB-TACE) for large liver cancer(maximum diameter >5 cm). Methods The clinical data of 228 patients with large liver cancer, who received DEB-TACE at the First Affiliated Hospital of Zhengzhou University of China between December 2016 and May 2020, were retrospectively analyzed. The postoperative 6-month and 12-month objective response rate(ORR), and the postoperative one-year and 2-year overall survival(OS) were calculated. Cox regression model was used to analyze the factors influencing patient’s outcome after DEB-TACE treatment. Results After DEB-TACE, all 228 patients were followed up for a mean period of 36.9 months with a maximum period of 62 months. The postoperative 6-month and 12-month ORRs after initial treatment were 55% and 43% respectively. The median OS time was 11.9 months(95%CI:8.6-14.8). The one-year survival rates in the patients with single lesion and in the patients with multiple lesions were54.1% and 36.9% respectively, in the patients who had unilobar lesions and in the patients who had bilobar lesions were 54.1% and 36.9% respectively, in the patients having capsule lesions and in the patients having non-capsule lesions were 56.5% and 47.1% respectively, and in the patients whose lesion volume was≤50% of the total liver volume and in the patients whose lesion volume was>50% of the total liver volume were 53.3%and 27.5% respectively. The 2-year survival rates in the patients with single lesion and in the patients with multiple lesions were 30.9% and 23.1% respectively, in the patients who had unilobar lesions and in the patients who had bilobar lesions were 31.4% and 17.1% respectively, in the patients having capsule lesions and in the patients having non-capsule lesions were 43.5% and 24.5% respectively, and in the patients whose lesion volume was≤50% of the total liver volume and in the patients whose lesion volume was >50% of the total liver volume were 32.0% and 5.5% respectively. The differences in all the above indexes were statistically significant(all P<0.05). Univariate analysis showed that tumor number, tumor capsule, tumor distribution,percentage of tumor volume to liver volume, Child-Pugh classification, and portal vein cancerous thrombus were the factors affecting patient survival. Multivariate analysis indicated that lesions’ volume>50% of liver volume, portal cancerous thrombus, and tumor capsule were the factors affecting patient survival.Conclusion For the treatment of large liver cancer, DEB-TACE is clinically safe and effective. Portal cancerous thrombus is an independent risk factor of DEB-TACE for large liver cancer, while tumor capsule is a protective factor.(J Intervent Radiol, 2023, 32: 781-785)更多还原