【摘要】 背景与目的:肝癌是我国的高发恶性肿瘤,预后不佳,分析预后相关因素和选择合适的综合治疗是提高疗效的有效手段。本研究通过分析病理确诊的肝癌病例,以发现新的预后相关因素并分析不同治疗模式的疗效差异。方法:通过随访回顾性分析了394例病理确诊的原发性肝癌病例,利用Cox回归模型筛选有独立影响的预后因素。应用Kaplan-Meier方法计算生存率,分析评价各治疗手段的疗效。结果:根据国内临床分期标准,394例中Ⅱ期病例247例(62.69%),Ⅲ期病例88例(22.34%)。总的中位生存期为359d。1、2、3、5年生存期分别为49.39%、22.65%、13.64%和8.81%。Cox多因素分析显示对患者生存期有独立影响的因素包括:腹腔淋巴结转移、门脉癌栓、血清AKP、LDH、GGT水平和肝功能分级。疗效分析显示放疗、介入化疗栓塞和中草药等均能改善预后,综合治疗的疗效要好于单一治疗。其中介入化疗栓塞结合放疗和中草药的中位生存期达到472d。结论:腹腔淋巴结转移、门脉癌栓、血清AKP、LDH、GGT水平、肝功能分级是与预后相关的因素。综合治疗有利于疗效的提高,介入化疗栓塞结合放疗和中草药是较理想的综合治疗模式。更多还原

【Abstract】 Background and purpose:The incidence of primary liver cancer in China is high and has a poor prognosis. Analysis of the prognosis factors and the appropriate combined therapy is a way to improve the survival rate. The risk factors of pathologically diagnosed hepatic carcinoma cases were analyzed and the outcomes of different therapeutic patterns were compared in this article. Methods:We retrospectively studied 394 cases of primary hepatic carcinoma. The Cox regression model was used to find the factors which independently determined the prognosis. The survival rate was calculated and the outcome of different treatments using the Kaplan-Meier method was evaluated.Results:According to China (Guangzhou) Staging,59(14.97%) cases with stageⅠ,247 (62.69%) cases with stage Ⅱ and 88 (22.34%) cases with stage Ⅲ disease were analyzed. The median survival time was 359 days. The survival rates at 1, 2, 3 and 5 years were 49.39%, 22.65%, 13.64% and 8.81%, respectively. The Cox regression models indicated the independent factors determining the prognosis were: lymph nodes metastasis, portal vein thrombus, serum AKP, LDH, GGT level and Child-Pugh Staging. The treatments which include trans-catheter arterial chemoembolization (TACE), radiation therapy and traditional Chinese medicine improved the survival time. The median survival time implied that integrated therapy was better than single therapy treatment. For patients treated with TACE, radiation and traditional Chinese medicine, the median survival time was 472 days.Conclusions:Lymph node metastasis, portal vein thrombus, serum AKP, LDH, GGT level and Child-Pugh staging are the independent factors relevant to the prognosis of hepatocarcinoma. Integrated therapy is beneficial for improving therapeutic effect. The combined treatment with TACE, radiation and traditional Chinese medicine is a potential and promising treatment for advanced hepatic carcinoma.更多还原