肝细胞癌患者根治性切除术后辅助性经皮肝动脉化疗栓塞与单纯栓塞疗效的比较研究

发布时间：2018-10-09 14:27

【摘要】：目的比较肝细胞癌(hepatocellular carcinoma,HCC)患者根治性切除术后辅助性经皮肝动脉化疗栓塞(Transarterial chemoembolization,TACE)与单纯经皮肝动脉栓塞(Transarterial embolization,TAE)对预后的作用。方法收集2010年4月至2016年4月期间,在山东省肿瘤医院接受根治性切除术的HCC患者共136例,所有患者术前均未行其他治疗;“根治性切除”的标准依据2011年中华人民共和国卫生部《原发性肝癌诊疗规范》中根治性切除II级标准;所有患者随访至2017年2月28日。仅行根治性切除术的36例患者为A组,根治性切除术后行辅助性TAE治疗的30例患者为B组,根治性切除术后行辅助性TACE治疗的70例患者为C组,根据患者临床资料进行预后及影响因素分析。结果三组患者在性别、年龄分布、肿瘤大小、甲胎蛋白(Alpha fetoprotein,AFP)、肝功能Child-Pugh分级、白蛋白(Albumin,ALB)、总胆红素(Total bilirubin,TBIL)、谷丙转氨酶(Alanine aminotransferase,ALT)、谷草转氨酶(Aspartate aminotransferase,AST)、γ-谷氨酰转肽酶(Gamma glutamyl transpeptidase,GGT)等方面均无显著性差异(P0.05),A组患者巴塞罗那临床肝癌(Barcelona clinical liver cancer,BCLC)分期相比B组和C组均较晚(P=0.012,P0.001)。A、B、C三组患者的1年、2年、3年总生存(Overall survival,OS)率依次为75.0%、75.0%、75.0%,93.3%、90.0%、86.7%和91.4%、87.1%、78.6%,A组与B组、C组之间1年OS率差异具有统计学意义(P=0.044,P=0.017),其余差异无统计学意义(P0.05);A、B、C三组患者的1年、2年、3年无复发生存(Recurrence-free survival,RFS)率依次为69.4%、63.9%、63.9%,76.7%、66.7%、66.7%和75.7%、68.6%、65.7%,差异均无统计学意义(P0.05)。Cox回归分析结果显示,肿瘤大小和微血管癌栓是影响术后复发的独立危险因素,也是影响预后的独立危险因素。结论1.对于行根治性切除术的HCC患者,术后行辅助性TAE或TACE治疗可以改善1年总生存率,但不能改善无复发生存率和远期总生存率;2.根治性切除术后行辅助性TAE与TACE的疗效没有差别。
[Abstract]:Objective to compare the prognostic effects of adjuvant percutaneous hepatic artery chemoembolization (Transarterial chemoembolization,TACE) and percutaneous hepatic artery embolization (Transarterial embolization,TAE) in patients with hepatocellular carcinoma (hepatocellular carcinoma,HCC) after radical resection. Methods from April 2010 to April 2016, 136 patients with HCC underwent radical resection in Shandong Cancer Hospital. The standard of "radical resection" was based on the standard of II level in 2011, Ministry of Health of the people's Republic of China. All patients were followed up until February 28, 2017. There were 36 patients with radical resection only in group A, 30 patients with adjuvant TAE after radical resection and 70 patients with adjuvant TACE after radical resection. The prognosis and influencing factors were analyzed according to the clinical data. Results Sex, age distribution, tumor size, alpha-fetoprotein (Alpha fetoprotein,AFP), liver function Child-Pugh grade were measured in the three groups. There was no significant difference in albumin (Albumin,ALB), total bilirubin (Total bilirubin,TBIL), alanine aminotransferase (Alanine aminotransferase,ALT), alanine aminotransferase (Aspartate aminotransferase,AST), 纬 -glutamyl transpeptidase (Gamma glutamyl transpeptidase,GGT). The total survival (Overall survival,OS) rate of 75.0% and 75.0% were 75.0%, 75.0%, 90.033% and 91.4%, 87.1%, 78.6A and 78.6A and B group C respectively, respectively (P 0.05). There was no significant difference in OS rate between group A and group B (P 0.05). (P0.05) there was no significant difference in OS rate between group A and group B (P 0.05). (P 0.05) there was no significant difference in OS rate between group A and group B (P 0.05), and there was no significant difference in OS rate between group A and group B (P 0.05). (P 0.05) there was no significant difference in OS rate between group A and group B (P 0.05). (P 0.05) there was no significant difference in OS rate between group A and group B (P 0.05). The recurrence survival (Recurrence-free survival,RFS) rate was 69.4%, 63.9% and 66.7%, 66.7% and 68.7%, respectively. The difference was not statistically significant (P0.05) .Cox regression analysis showed that there was no significant difference between the two groups. Tumor size and microvascular tumor thrombus are independent risk factors for postoperative recurrence and prognosis. Conclusion 1. For patients with HCC undergoing radical resection, adjuvant TAE or TACE therapy can improve 1-year overall survival rate, but can not improve recurrence free survival rate and long-term overall survival rate. There was no difference between the curative effect of adjuvant TAE and TACE after radical resection.
【学位授予单位】：济南大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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