BCLCC期肝细胞癌不同治疗模式的疗效及预后影响因素分析

发布时间：2018-06-11 13:57

本文选题：肝细胞癌 + 经肝动脉化疗栓塞术　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:BCLC C期肝细胞癌治疗模式多种多样,目前我国还没有统一的规范和标准。本文回顾性分析我院BCLC C期肝细胞癌不同治疗模式及预后影响因素,以探讨其最佳治疗方法及预后影响因素。方法:收集2005.01-2012.12在我院首诊111例BCLC C期肝细胞癌患者的临床资料,按治疗方法分为:单纯TACE组(n=29)、TACE+索拉非尼组(n=20)、TACE+消融组(n=21)、手术+TACE组(n=24)、手术+TACE+消融组(n=17)。采用Kaplan-Meier法进行生存分析,运用Log-Rank法检验。运用COX风险模型分析影响BCLC C期肝细胞癌患者预后因素。结果:单纯TACE组:中位生存期为16月,1、2、3年生存率为64.7%、22.7%、0%;TACE+索拉非尼组:中位生存期为12月,1、2、3年生存率为46.8%、23.2%、8.8%;TACE+消融组:中位生存期36月,1、2、3年生存率分别为:70%、46.4%、46.4%;手术+TACE组:中位生存期为21月,1、2、3年生存率分别为:73.7%、73.7%、59.0%。手术+TACE+消融组:中位生存期19月,1、2、3年生存率分别为:94.1%、94.1%、80.9%。将各组进行两两比较,结果示:手术+TACE+消融组总生存期较单纯TACE组、TACE+索拉非尼组和手术+TACE组高,差异性有统计学意义(P0.05),而与TACE+消融组相比无统计学差异(P0.05);TACE+消融组总生存期较单纯TACE组、TACE+索拉非尼组高,差异性有统计学意义(P0.05),而与手术+TACE组和手术+TACE+消融相比无统计学差异(P0.05);手术+TACE组总生存期较TACE+索拉非尼组高,差异性有统计学意义(P0.05),而与TACE+消融组、单纯TACE组相比无统计学差异(P0.05);单纯TACE组总生存期与TACE+索拉非尼相比,差异性无统计学意义(P0.05)。单因素分析结果显示:年龄(P=0.028)、肿瘤大体分型(P=0.041)、肝外转移(P=0.010)、肿瘤最大直径(P=0.008)、治疗模式(P=0.000)差异有统计学意义。多因素结果显示:肿瘤最大直径、肝外转移、治疗模式是影响预后的独立因素。结论:肿瘤最大径、肝外转移、治疗模式是影响BCLC C期肝细胞癌患者预后的独立因素;对于可手术切除的BCLC C期肝细胞癌患者,手术+TACE+消融治疗可延长患者生存时间;对于不能手术切除BCLC C期肝细胞癌患者,TACE+消融治疗可延长患者生存时间;TACE+索拉非尼治疗未能显著延长BCLC C期肝细胞癌患者生存时间,尚需大样本、多中心、随机、双盲、前瞻性研究来验证。
[Abstract]:Objective: there are many kinds of treatment modes for stage C hepatocellular carcinoma (HCC) in BCLC, but there is no uniform standard and standard in China. In this paper, we retrospectively analyzed the different treatment modes and prognostic factors of BCLC C stage hepatocellular carcinoma (HCC) in order to explore the best treatment method and prognostic factors. Methods: the clinical data of 111 patients with BCLC stage hepatocellular carcinoma (HCC) in our hospital from January to February 2012 were collected and divided into two groups: simple TACE group (n = 29), TACE group (n = 20), TACE ablation group (n = 21), surgical TACE group (n = 24), and surgical TACE ablation group (n = 1717). Kaplan-Meier method was used to analyze survival and Log-Rank method was used to test it. Cox risk model was used to analyze the prognostic factors of patients with BCLC C hepatocellular carcinoma. Results: in the simple TACE group, the median survival time was 16 months, and the 3-year survival rate was 64.7 and 22.77.The median survival time was 12 months and the 3-year survival rate was 46.8 months and 23.28.8cm, respectively. The median survival time was 36 months and the 3-year survival rate was: the mean survival time was 30 months and 46.4.The operative TACE group was the same as the TACE group, and the operative TACE group was the same as the operation TACE group: the median survival time was 36 months and the 3-year survival rate was respectively: 70%, 46.4%, 46.44.The median survival time of the TACE group was 64.7%, and the 3-year survival rate was 64.7%. The median survival time was 21 months / 1 / 2, and the 3 year survival rate was 1 / 73.7and 73.7 / 59.0, respectively. In the TACE ablation group, the median survival time was 19 months and the 3-year survival rate was 1: 94. 1 and 94. 1%, respectively. The results showed that the total survival time of TACE ablation group was longer than that of TACE alone group and operative TACE group. There was no significant difference between TACE ablation group and TACE ablation group. The total survival time of TACE ablation group was higher than that of simple TACE group, and the total survival time of TACE ablation group was higher than that of TACE alone group, but there was no significant difference between TACE ablation group and TACE ablation group. The difference was statistically significant (P 0.05), but there was no significant difference compared with TACE group and TACE ablation group, the total survival time of operation TACE group was higher than that of TACE Solafenil group, the difference was statistically significant (P 0.05), but that of TACE ablation group was higher than that of TACE ablation group. There was no statistical difference between TACE group and TACE group, but there was no significant difference in total survival time between TACE group and TACE group (P 0.05). The results of univariate analysis showed that there were significant differences in age (P < 0.028), gross classification (P < 0.041), extrahepatic metastasis (P = 0.010), maximum diameter of tumor (P = 0.008) and treatment mode (P = 0.000). Multivariate results showed that the maximum diameter of tumor, extrahepatic metastasis and treatment mode were independent factors affecting prognosis. Conclusion: the maximum diameter of tumor, extrahepatic metastasis and treatment mode are independent factors influencing the prognosis of patients with BCLC C hepatocellular carcinoma, and the survival time can be prolonged by TACE ablation for patients with resectable BCLC C hepatocellular carcinoma. TACE ablation can prolong the survival time of patients with BCLC C stage hepatocellular carcinoma. The survival time of patients with BCLC stage hepatocellular carcinoma can not be significantly prolonged by TACE solafenil therapy. Large sample, multi-center, random, double-blind are needed. Prospective studies to verify.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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