杭州标准在宁夏地区肝癌切除术后辅助性肝动脉栓塞化疗的临床效果分析

发布时间：2018-06-19 12:17

本文选题：原发性肝癌 + TACE　；参考：《宁夏医科大学》2017年硕士论文

【摘要】：目的通过对杭州标准在宁夏地区肝癌切除术后行辅助性肝动脉栓塞化疗(TACE)的临床效果进行分析,探讨杭州标准对肝癌切除术后行辅助性TACE治疗临床病例选择的指导意义。方法查阅宁夏医科大学总医院肝胆外科在2008年1月至2013年12月间行肝癌切除术并术后病理报告为肝细胞性肝癌患者的病例资料,收集临床资料齐全的患者274例,其中108例患者仅单纯行手术治疗,166例患者术后行预防性TACE治疗。根据患者行TACE的次数,分为未行TACE组、一次TACE组、两次TACE组及多次TACE组,对比患者术后1、2、3年的无瘤生存率及总生存率,探讨预防性TACE在不同患者群体中的效果。采用Kaplan-Meier法将肝切除术后的预后相关危险因素及术后无瘤生存率、总体生存率进行单因素分析,受试者工作特征曲线对诊断精度进行预测。结果用Kaplan-Meier生存分析显示杭州标准及TNM分期对肝癌切除术后患者的预后都能进行预测,而杭州标准的预测能力比TNM分期明显要高。分别采用TNM分期和杭州标准对术后复发做预测分析,绘制ROC曲线,结果显示TNM分期对术后肿瘤复发预测的曲线下面积(AUC)为0.614,95%CI为0.547~0.681;杭州标准对术后肿瘤复发预测的AUC为0.694,95%CI为0.633~0.756;由此可见,杭州标准对肝癌术后复发的预测能力好于TNM分期,其差异有统计学意义(Z=1.733,p=0.042)。对于符合杭州标准的患者,四组的1年、2年、3年无瘤生存率分别为85.34%、72.41%、57.76%;77.50%、57.50%、47.50%;76.19%、52.38%、47.62%;85.71%、57.14%、42.86%。1年、2年、3年总生存率分别为97.41%、89.66%、65.52%;92.50%、87.50%、80.00%;96.48%、71.43%、52.38%;100%、92.86%、57.14%。四组患者间的临床病例数据具有可比性,但无瘤生存率及总生存率无统计学差异(所有的P0.05)。对于超出杭州标准的患者,四组的1年、2年、3年无瘤生存率分别为66.00%、10.00%、6.00%;73.33%、40.00%、40.00%;69.23%、38.46%、23.08%;85.71%、71.43%、42.86%。1年、2年、3年总生存率分别为86.00%、46.00%、24.00%;93.33%、66.67%、40.00%;84.62%、69.23%、53.85%;100%、85.71%、57.14%。四组临床病例数据也具有可比性,其中未行TACE组比其他三组的无瘤生存率及总生存率都低(所有的P值0.05)。然而,行TACE组之间的无瘤生存率与总生存率无明显差异(所有的P值均0.05)。结论1、杭州标准及TNM分期对肝癌切除术后患者的预后都能进行预测,而杭州标准的预测能力比TNM分期明显要高。2、符合杭州标准的患者肝癌根治性切除术后行辅助性TACE治疗的临床疗效要好于超出杭州标准的患者。因此,杭州标准可以用来指导宁夏地区辅助性TACE治疗的临床病例选择。3、超出杭州标准的患者建议行一次辅助性TACE治疗可防治术后肿瘤的复发,提高术后远期生存率。多次TACE治疗并不能使该类患者的无瘤生存期及总生存期得到明显的改善。
[Abstract]:Objective to analyze the clinical effect of TACE-assisted hepatic artery chemoembolization (TACE-TACE) after resection of hepatocellular carcinoma (HCC) in Ningxia area, and to explore the guiding significance of Hangzhou standard in the selection of clinical cases of TACE after hepatectomy. Methods from January 2008 to December 2013, patients with hepatocellular carcinoma (HCC) were treated by hepatobiliary surgery in General Hospital of Ningxia Medical University. 274 patients with HCC were collected. One hundred and eight patients received only surgical treatment and 166 patients received prophylactic TACE after operation. According to the times of TACE, the patients were divided into three groups: no TACE group, one TACE group, two TACE group and multiple TACE group. The tumor-free survival rate and the overall survival rate were compared between 1 and 3 years after operation, and the effect of prophylactic TACE in different patient groups was discussed. Kaplan-Meier method was used to analyze the prognostic risk factors, tumor free survival rate and overall survival rate after hepatectomy. The diagnostic accuracy was predicted by the operating characteristic curve. Results Kaplan-Meier survival analysis showed that both Hangzhou criteria and TNM staging could predict the prognosis of patients after hepatectomy, but Hangzhou criteria had higher predictive power than TNM staging. TNM staging and Hangzhou standard were used to predict postoperative recurrence, and ROC curves were drawn. The results showed that the area under the curve of TNM staging for predicting postoperative tumor recurrence was 0.614 ~ (95) CI was 0.547 ~ (0.681), and the AUC of Hangzhou standard for postoperative tumor recurrence was 0.633 ~ 0.756. It can be seen that Hangzhou standard is better than TNM stage in predicting postoperative recurrence of liver cancer. The difference was statistically significant. For those patients who meet the Hangzhou standard, the one-year, 2-year and 3-year tumor-free survival rates of the four groups were 85.34 and 72.41and 57.507.507.5077.5077.5077.5077.50A, respectively. They were involved in the work of 47.507.5076.1976.197.52.380.The total survival rate of the four groups was 97.411,89.65.29.5087.5087.50 and 80.0096.488.4851.4351.4352.3852.3852.3857.450.The overall survival rate was 97.411,89.6665.5292.5087.5057.57.57.57.140.The overall survival rate was 97.4116.65.29.50% 87.500.87.47.47.47.450.The overall survival rate of the four groups was 87.411and 87.500.57.47.500.The total survival rate was 87.441. The clinical data of the four groups were comparable, but there was no significant difference in tumor free survival rate and overall survival rate (all P 0.05). For those patients exceeding the Hangzhou standard, the one-year, 2-year and 3-year tumor-free survival rates of the four groups were 66.00 and 10.00 respectively. 73.336.00 and 40.0040.0040.0040.0040.0040.0040.0040.0040.0040.0040.0040.0040.0040.0040.0040.0040.0040.0049.2338.460.The total survival rate of the patients in the four groups was 86.00, 46.00 and 24.000.The overall survival rate was 66.00, 10.00 and 6.00 respectively. It was 79.238.40.0040.0040.0040.0040.0040.0040.0049.238.468.085.710.The total survival rate for the four groups was 86.00, 46.00 and 24.000.The total survival rate for the four groups was 66.00, 10.00 and 6.00, respectively. The clinical data of the four groups were also comparable. The tumor-free survival rate and overall survival rate of the non-TACE group were lower than those of the other three groups (all P values were 0.05). However, there was no significant difference in tumor-free survival rate and overall survival rate between TACE groups (all P values were 0.05). Conclusion 1.Hangzhou standard and TNM staging can predict the prognosis of patients after hepatectomy. The predictive ability of Hangzhou standard was significantly higher than that of TNM staging, and the clinical efficacy of adjuvant TACE after radical resection of hepatocellular carcinoma was better than that of patients beyond Hangzhou standard. Therefore, Hangzhou standard can be used to guide the clinical case selection of adjuvant TACE treatment in Ningxia area. The patients who exceed Hangzhou standard suggest that one time auxiliary TACE therapy can prevent the recurrence of postoperative tumor and improve the long-term survival rate. Multiple TACE therapy did not significantly improve the tumor-free survival and total survival of these patients.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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