肝细胞癌术后序贯非特异性免疫治疗的临床研究

发布时间：2018-06-15 15:17

本文选题：肝细胞癌 + 肝切除　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的探讨肝细胞癌术后序贯非特异性免疫治疗(胸腺法新+白介素-2)的疗效及预后影响因素。方法按照知情同意原则,将2011年1月至2014年12月在广西壮族自治区人民医院肝胆外科收治符合纳入标准的154例肝细胞癌患者分为三组:单纯手术切除组(A组)57例;手术+1-3个疗程免疫治疗组(B组)53例;手术+≥4个疗程免疫治疗组(C组)44例。采用Kaplan-Meier法分析术后肿瘤复发情况和患者生存情况;Cox比列风险回归模型分析影响术后生存的因素。结果1.A、B、C组术后中位复发时间分别为25、28和31个月,三组之间的差异无统计学意义(P=0.484)。术后1、3、5年的累积复发率分别为32.1%、65.2%和87.1%;29.9%、56.6%和81.3%;26.1%、53.7%和77.5%;术后1、3、5年的累积生存率分别为79.7%、50.3%和20.0%;90.1%、69.9%和38.8%;92.7%、71.1%和41.5%。2.A、B、C组中位生存时间分别为41、47和49个月,三组之间的差异有统计学意义(P=0.023),两两比较,A组与B组、A组与C组的差异均有统计学意义(P=0.042和P=0.015),而B组与C组之间的差异无统计学意义(P=0.649)。3.单因素分析显示肿瘤分化程度、肿瘤直径、巴塞罗那分期、术前AFP水平是影响肝癌术后生存的预后因素(P0.05);多因素分析显示肿瘤分化程度是影响肝癌术后生存的独立危险因素(P=0.044)。结论肝细胞癌术后序贯胸腺法新联合IL-2非特异性免疫治疗可以延长生存时间,其疗效可能与免疫治疗的疗程数呈正相关,肿瘤分化程度是影响术后生存的独立危险因素。
[Abstract]:Objective to investigate the efficacy and prognostic factors of sequential nonspecific immunotherapy (SNS) for hepatocellular carcinoma (HCC). Methods according to the principle of informed consent, 154 patients with hepatocellular carcinoma treated in the Department of Hepatobiliary surgery, Guangxi Zhuang Autonomous region people's Hospital, from January 2011 to December 2014, were divided into three groups: group A, simple surgical resection, group A, 57 cases; There were 53 cases in Group B and 44 cases in Group C in Group B and Group C respectively. Kaplan-Meier method was used to analyze the recurrence and survival of the patients. Results 1. The median recurrence time of group A was 2528 and 31 months, respectively. There was no significant difference among the three groups (P < 0. 484). The cumulative recurrence rates were 32.2% and 87.1%, and 56.6% and 81.3%, respectively, and 53.7% and 77.5%, respectively. The cumulative survival rates were 79.70.3% and 20.090.1%, 69.9% and 20.090.1% and 38.87.71.1% and 41.5%, 41.5% and 49 months, respectively. The difference among the three groups was statistically significant (P 0.023). There were significant differences between group A and group B (P 0.042) and group C (P 0.015), but there was no significant difference between group B and group C (P 0.649). Univariate analysis showed that tumor differentiation degree, tumor diameter, Barcelona stage and AFP level before operation were the prognostic factors for the survival of HCC after operation, and multivariate analysis showed that the degree of tumor differentiation was an independent risk factor for the survival of HCC after operation. Conclusion Sequential thymus therapy combined with IL-2 nonspecific immunotherapy can prolong the survival time after operation for hepatocellular carcinoma. The curative effect may be positively correlated with the number of courses of immunotherapy. The degree of tumor differentiation is an independent risk factor for postoperative survival.
【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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