术前TACE肿瘤坏死程度影响肝癌根治术后患者远期预后
发布时间：2018-08-13 18:44
【摘要】：目的:研究术前肝动脉化疗栓塞术(Transcatheter Arterial Chemoembolization,TACE)坏死程度是否与肝癌患者的远期生存率有相关性。方法:回顾性分析2009年至2016年期间在大连医科大学附属第二医院住院治疗的34例原发性肝癌患者,经手术病理报告均为肝细胞癌,所有研究对象均选择TACE作为第一辅助治疗方案,序贯TACE后或者至少一次TACE后行手术治疗,TACE采用常规Seldinger方法,根据病理结果我们将术前TACE肿瘤坏死程度分为完全坏死组肝癌患者和不完全坏死组肝癌患者,并以此将34例例患者分为两组,即完全坏死组肝癌患者组和不完全坏死组肝癌患者组,完全坏死组肝癌患者为8例,不完全坏死组肝癌患者为26例,同时根据影像学表现及WHO世界实体瘤大小评价标准将TACE术后肿瘤反应分为完全缓解、部分缓解、进展和稳定,用独立t检验分析计量资料及分类变量等一般资料,用Kaplan-Meier生存曲线分析比较完全坏死组肝癌患者和不完全坏死组肝癌患者的无瘤生存期及总生存期。logistic多因素回归分析影响术前TACE肿瘤坏死程度的影响因素。结果:两组的平均年龄:肿瘤完全坏死组肝癌患者的肝癌患者平均年龄为53.58岁,肿瘤不完全坏死组肝癌患者的肝癌患者平均年龄为51.54岁,差异无显著性。完全坏死组肝癌患者组肝癌患者的慢性乙型肝炎率为100%,不完全坏死组肝癌患者的慢性乙型肝炎为19例,非乙型肝炎为7例。两组的Child-Pugh分级均为A级和B级,完全坏死组肝癌患者有一个为B级,不完全坏死组肝癌患者则有2例B级;由于AFP在检验结果中单位的不同,我们仅将其分为正常组及异常组,完全坏死组肝癌患者有2位患者AFP为正常,而不完全坏死组肝癌患者则有14例正常;同样的我们通过CT、MRI等查看了门脉癌栓情况,完全坏死组肝癌患者有1例患者有门脉癌栓,而不完全坏死组肝癌患者则有4例门脉癌栓,完全坏死组肝癌患者术前多次TACE的有3例,而不完全坏死组肝癌患者多次TACE的患者有6例,完全坏死组肝癌患者的平均TACE-手术时间间隔为202.6天,不完全坏死组肝癌患者的平均TACE-手术时间间隔为114.5天,我们调查发现,完全坏死组肝癌患者有1例患者为III期,不完全坏死组肝癌患者有6位患者为III期,坏死组的平均肿瘤直径为3.35cm,不完全坏死组肝癌患者的平均肿瘤直径为4.058cm,完全坏死组肝癌患者有4例患者在右半肝,4例在左半肝,而不完全坏死组肝癌患者则有19例在右半肝,7例在左半肝。完全坏死组肝癌患者的平均血小板水平为145.85*10^9/L,不完全坏死组肝癌患者的平均血小板水平为150.98*10^9/L;完全坏死组肝癌患者的平均凝血酶原时间为14.11秒,不完全坏死组肝癌患者的平均凝血酶原时间为13.41秒,平均总胆红素水平在完全坏死组肝癌患者组为17.05umol/L,在不完全坏死组肝癌患者组为17.01umol/L,以上情况在完全坏死组肝癌患者组和不完全坏死组肝癌患者组经独立t检验均无显著差异。肝癌术前TACE肿瘤完全坏死组肝癌患者的中位无瘤生存期为35.43个月,不完全坏死组肝癌患者的中位无瘤生存期为19.78个月,差异经时序检验(LogRank test)分析有显著性(p=0.009),总生存期则无差异。多因素分析发现肿瘤大小以及是否为多次TACE以及肿瘤反应程度均不是肿瘤是否完全坏死的预测因素。结论:肝癌患者术前TACE肿瘤完全坏死的肝癌患者中位无瘤生存期要显著长于不完全坏死组的肝癌患者,完全坏死组中位总生存期虽然高于术前TACE不完全坏死组肝癌患者,但是统计学无差异。
[Abstract]:Objective: To study whether the degree of necrosis of preoperative transcatheter arterial chemoembolization (TACE) is related to the long-term survival rate of patients with hepatocellular carcinoma (HCC). Methods: A retrospective analysis was made of 34 patients with HCC hospitalized in the Second Affiliated Hospital of Dalian Medical University from 2009 to 2016. All patients were treated with TACE as the first adjuvant therapy. After sequential TACE or at least one TACE, TACE was performed with routine Seldinger method. According to the pathological results, the degree of tumor necrosis before TACE was divided into complete necrosis group and incomplete necrosis group. Thirty-four patients were divided into two groups: complete necrosis group and incomplete necrosis group, complete necrosis group and incomplete necrosis group. There were 8 cases of complete necrosis group and 26 cases of incomplete necrosis group. Kaplan-Meier survival curve was used to analyze the tumor-free survival and total survival of patients with complete necrosis and those with incomplete necrosis. Logistic multivariate regression analysis was used to analyze the influencing factors of tumor necrosis before TACE. Results: The average age of the two groups was 53.58 years in the complete necrosis group and 51.54 years in the incomplete necrosis group. The chronic hepatitis B rate was 100% in the complete necrosis group and 100% in the incomplete necrosis group. There were 19 cases of chronic hepatitis B and 7 cases of non-hepatitis B. The Child-Pugh grades of both groups were A and B. One of the patients with complete necrosis and two of the patients with incomplete necrosis were B. Fourteen patients with normal AFP and 14 patients with incomplete necrosis of liver cancer were normal. Similarly, we examined the portal vein tumor thrombus by CT and MRI. One patient with complete necrosis of liver cancer had portal vein tumor thrombus, four patients with incomplete necrosis of liver cancer had portal vein tumor thrombus, and three patients with complete necrosis of liver cancer had multiple TACE before operation. There were 6 patients with multiple TACE in the incomplete necrosis group. The mean TACE-operation time interval was 202.6 days in the complete necrosis group and 114.5 days in the incomplete necrosis group. We found that 1 patient with complete necrosis group had stage III liver cancer and 1 patient with incomplete necrosis group had stage III liver cancer. Six patients had stage III, the average diameter of tumor in necrosis group was 3.35 cm, the average diameter of tumor in incomplete necrosis group was 4.058 cm, four patients in complete necrosis group were in right liver, four patients in left liver, 19 patients in incomplete necrosis group were in right liver, and seven patients in left liver. The mean platelet level was 145.85 * 10 ^ 9 / L in the complete necrosis group, 150.98 * 10 ^ 9 / L in the incomplete necrosis group, 14.11 seconds in the complete necrosis group, 13.41 seconds in the incomplete necrosis group and 13.41 seconds in the complete necrosis group. The median tumor-free survival time was 35.43 months in the TACE group and 35.43 months in the incomplete necrosis group. The median tumor-free survival time of HCC patients was 19.78 months. The difference was statistically significant by LogRank test (p = 0.009), but there was no difference in total survival time. The median tumor-free survival time of patients with complete necrosis was significantly longer than that of patients with incomplete necrosis. Although the median total survival time of patients with complete necrosis was higher than that of patients with TACE incomplete necrosis, the difference was not statistically significant.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7
本文编号：2181851
[Abstract]:Objective: To study whether the degree of necrosis of preoperative transcatheter arterial chemoembolization (TACE) is related to the long-term survival rate of patients with hepatocellular carcinoma (HCC). Methods: A retrospective analysis was made of 34 patients with HCC hospitalized in the Second Affiliated Hospital of Dalian Medical University from 2009 to 2016. All patients were treated with TACE as the first adjuvant therapy. After sequential TACE or at least one TACE, TACE was performed with routine Seldinger method. According to the pathological results, the degree of tumor necrosis before TACE was divided into complete necrosis group and incomplete necrosis group. Thirty-four patients were divided into two groups: complete necrosis group and incomplete necrosis group, complete necrosis group and incomplete necrosis group. There were 8 cases of complete necrosis group and 26 cases of incomplete necrosis group. Kaplan-Meier survival curve was used to analyze the tumor-free survival and total survival of patients with complete necrosis and those with incomplete necrosis. Logistic multivariate regression analysis was used to analyze the influencing factors of tumor necrosis before TACE. Results: The average age of the two groups was 53.58 years in the complete necrosis group and 51.54 years in the incomplete necrosis group. The chronic hepatitis B rate was 100% in the complete necrosis group and 100% in the incomplete necrosis group. There were 19 cases of chronic hepatitis B and 7 cases of non-hepatitis B. The Child-Pugh grades of both groups were A and B. One of the patients with complete necrosis and two of the patients with incomplete necrosis were B. Fourteen patients with normal AFP and 14 patients with incomplete necrosis of liver cancer were normal. Similarly, we examined the portal vein tumor thrombus by CT and MRI. One patient with complete necrosis of liver cancer had portal vein tumor thrombus, four patients with incomplete necrosis of liver cancer had portal vein tumor thrombus, and three patients with complete necrosis of liver cancer had multiple TACE before operation. There were 6 patients with multiple TACE in the incomplete necrosis group. The mean TACE-operation time interval was 202.6 days in the complete necrosis group and 114.5 days in the incomplete necrosis group. We found that 1 patient with complete necrosis group had stage III liver cancer and 1 patient with incomplete necrosis group had stage III liver cancer. Six patients had stage III, the average diameter of tumor in necrosis group was 3.35 cm, the average diameter of tumor in incomplete necrosis group was 4.058 cm, four patients in complete necrosis group were in right liver, four patients in left liver, 19 patients in incomplete necrosis group were in right liver, and seven patients in left liver. The mean platelet level was 145.85 * 10 ^ 9 / L in the complete necrosis group, 150.98 * 10 ^ 9 / L in the incomplete necrosis group, 14.11 seconds in the complete necrosis group, 13.41 seconds in the incomplete necrosis group and 13.41 seconds in the complete necrosis group. The median tumor-free survival time was 35.43 months in the TACE group and 35.43 months in the incomplete necrosis group. The median tumor-free survival time of HCC patients was 19.78 months. The difference was statistically significant by LogRank test (p = 0.009), but there was no difference in total survival time. The median tumor-free survival time of patients with complete necrosis was significantly longer than that of patients with incomplete necrosis. Although the median total survival time of patients with complete necrosis was higher than that of patients with TACE incomplete necrosis, the difference was not statistically significant.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7
【参考文献】
相关期刊论文 前1条
1 Yi-Xiang J.Wang;Thierry De Baere;Jean-Marc Idee;Sebastien Ballet;;Transcatheter embolization therapy in liver cancer:an update of clinical evidences[J];Chinese Journal of Cancer Research;2015年02期
，本文编号：2181851
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