肝细胞性肝癌TACE术后影响疗效的多因素分析
发布时间：2018-11-23 17:41
【摘要】：目的:探讨肝细胞性肝癌(hepatocellular carcinoma,HCC)经导管肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)治疗后影响TACE疗效的因素和影响碘油沉积的因素。方法:回顾性分析89例HCC患者经TACE治疗前后的临床及影像资料,对患者的年龄、性别、乙肝表面抗原(Hepatitis B surface antigen HBs Ag)血清总胆红素(total bilirubin TBIL)、血清白蛋白(Serumalbumin ALB)、谷草转氨酶(Aspertate Aminotransferase AST)谷丙转氨酶(Alanine Aminotransferase ALT)、碱性磷酸酶同工酶-1(alkaline phospha-tase isosyme ALP-1)、治疗前肿瘤的体积/肝脏的体积(tumor to liver volume ratio TTLVR),门静脉癌栓(portal vein tumor thrombus PVTT)、腹水(±)、AFP及治疗次数、使用的化疗药物、最后一次治疗后的最近复查时间、碘油的沉积形态等资料进行收集,并用CT体积测量工具测算治疗前肿瘤的体积/肝脏的体积(tumor to liver volume ratio TTLVR)、碘油沉积的体积/肝脏的体积(lipiodol deposition rate LDR)、治疗前后肿瘤体积的变化(tumor shrinkage ratio TSR),对上述资料分别采用秩和检验和spearman单因素分析影响TACE的因素和影响碘油沉积的因素,对有统计学意义的采用cox多元线性回归分析影响TACE疗效的独立相关因素。并将LDR分组比较,两组间的差异用LSD法分析。结果:1、治疗前PVTT(P0.001,Z/?2=-4.680)、腹水(P=0.045,rs=-1.225)、AFP(P=0.039,rs=-0.219)、ALP-1(P=0.04,rs=-0.306),TTLVR(P=0.042,rs=-0.216)为影响TSR的负相关因素,碘油的沉积形态(P=0.005,rs=1.370)、LDR(P0.001,rs=0.728)为正相关因素,其中PVTT(P=0.027)、ALP-1(P=0.005)、治疗前TTLVR(P=0.017)、LDR(P0.001)为独立影响因素,以LDR影响因素为最重要。2、年龄(P=0.016,rs=-0.254)、治疗前PVTT(P0.001,Z/?2=-4.289)、TTLVR(P0.001,rs=-0.385)是影响碘油沉积的负相关因素。结论:1、影响肝癌TACE疗效独立危险因素有:治疗前有无门静脉癌栓、碱性磷酸酶同工酶-1、肿瘤的体积大小及治疗后碘油的沉积量,其中以碘油的沉积量为最主要危险因素,不同的碘油沉积量导致肿瘤体积的变化有明显不同。2、影响碘油沉积的危险因素有:年龄、治疗前肿瘤的大小、有无门静脉癌栓。3、CT平扫加增强是肝细胞性肝癌经TACE治疗后评价其疗效较常用的无创随访方法,加上其对治疗前后肿瘤的体积、肿瘤的体积变化(TSR)、碘油沉积率(LDR)的测定及结合相关实验室指标有助于临床对HCC经TACE治疗后的疗效判定。
[Abstract]:Objective: to investigate the factors affecting the effect of TACE and lipiodol deposition after transcatheter hepatic artery chemoembolization (transcatheter arterial chemoembolization,TACE) for hepatocellular carcinoma (hepatocellular carcinoma,HCC). Methods: the clinical and imaging data of 89 patients with HCC before and after TACE treatment were retrospectively analyzed. The age, sex, serum total bilirubin (total bilirubin TBIL), albumin (Serumalbumin ALB), of (Hepatitis B surface antigen HBs Ag) patients were analyzed retrospectively. Glutamic oxaloacetic transaminase (Aspertate Aminotransferase AST) alanine aminotransferase (Alanine Aminotransferase ALT), alkaline phosphatase isozyme 1 (alkaline phospha-tase isosyme ALP-1), volume of tumor / volume of liver (tumor to liver volume ratio TTLVR), before treatment The data of (portal vein tumor thrombus PVTT), ascites (卤), AFP), the times of treatment, the chemotherapeutic drugs used, the latest reexamination time after the last treatment, and the deposition of lipiodol were collected. Measurement of tumor volume / liver volume before and after treatment with CT volume measurement tool (tumor to liver volume ratio TTLVR), lipiodol deposition volume / liver volume (lipiodol deposition rate LDR), changes before and after treatment (tumor shrinkage ratio TSR), The factors affecting TACE and lipiodol deposition were analyzed by rank sum test (RSR) and spearman single factor analysis, and the independent correlation factors of TACE efficacy were analyzed statistically by cox multivariate linear regression analysis. The difference between the two groups was analyzed by LSD method. Results: 1. Before treatment, PVTT (P0.001), ascites (P0. 045), AFP () -1.225), AFP (, ALP-1 (P0. 04 ~ 0. 046), TTLVR (), ascitic fluid (P0. 045), AFP (), ALP-1 (P0. 04), AFP ()-0. 306), TTLVR (- 0. 042, respectively. Rs=-0.216) was a negative correlation factor of TSR, and the depositional morphology of lipiodol oil (P0. 005), LDR () was a positive correlation factor, in which PVTT (P0. 027), ALP-1 (P0. 005), TTLVR (P0. 017), LDR (P0. 001) was the independent influencing factor before treatment. LDR was the most important factor. 2, age (P0. 016), PVTT before treatment (P0. 001) -4. 289), TTLVR (P0. 001), before treatment (P0. 001% -4. 289), TTLVR (P0. 001). Rs=-0.385) is a negative correlation factor affecting lipiodol deposition. Conclusion: 1. The independent risk factors influencing the curative effect of TACE were: portal vein tumor thrombus, alkaline phosphatase isozyme 1, tumor volume and lipiodol after treatment. Among them, the amount of lipiodol deposition was the most important risk factor, and different amount of lipiodol deposition resulted in the change of tumor volume. 2. The risk factors affecting lipiodol deposition were: age, tumor size before treatment. 3T plain scan plus enhancement is a common noninvasive follow-up method for evaluating the efficacy of TACE in evaluating the curative effect of hepatocellular carcinoma after treatment, plus the volume of tumor before and after treatment, and the change of tumor volume, (TSR),. The determination of lipiodol deposition rate (LDR) and related laboratory indexes are helpful to evaluate the clinical efficacy of HCC treated with TACE.
【学位授予单位】：四川医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.7
本文编号：2352268
[Abstract]:Objective: to investigate the factors affecting the effect of TACE and lipiodol deposition after transcatheter hepatic artery chemoembolization (transcatheter arterial chemoembolization,TACE) for hepatocellular carcinoma (hepatocellular carcinoma,HCC). Methods: the clinical and imaging data of 89 patients with HCC before and after TACE treatment were retrospectively analyzed. The age, sex, serum total bilirubin (total bilirubin TBIL), albumin (Serumalbumin ALB), of (Hepatitis B surface antigen HBs Ag) patients were analyzed retrospectively. Glutamic oxaloacetic transaminase (Aspertate Aminotransferase AST) alanine aminotransferase (Alanine Aminotransferase ALT), alkaline phosphatase isozyme 1 (alkaline phospha-tase isosyme ALP-1), volume of tumor / volume of liver (tumor to liver volume ratio TTLVR), before treatment The data of (portal vein tumor thrombus PVTT), ascites (卤), AFP), the times of treatment, the chemotherapeutic drugs used, the latest reexamination time after the last treatment, and the deposition of lipiodol were collected. Measurement of tumor volume / liver volume before and after treatment with CT volume measurement tool (tumor to liver volume ratio TTLVR), lipiodol deposition volume / liver volume (lipiodol deposition rate LDR), changes before and after treatment (tumor shrinkage ratio TSR), The factors affecting TACE and lipiodol deposition were analyzed by rank sum test (RSR) and spearman single factor analysis, and the independent correlation factors of TACE efficacy were analyzed statistically by cox multivariate linear regression analysis. The difference between the two groups was analyzed by LSD method. Results: 1. Before treatment, PVTT (P0.001), ascites (P0. 045), AFP () -1.225), AFP (, ALP-1 (P0. 04 ~ 0. 046), TTLVR (), ascitic fluid (P0. 045), AFP (), ALP-1 (P0. 04), AFP ()-0. 306), TTLVR (- 0. 042, respectively. Rs=-0.216) was a negative correlation factor of TSR, and the depositional morphology of lipiodol oil (P0. 005), LDR () was a positive correlation factor, in which PVTT (P0. 027), ALP-1 (P0. 005), TTLVR (P0. 017), LDR (P0. 001) was the independent influencing factor before treatment. LDR was the most important factor. 2, age (P0. 016), PVTT before treatment (P0. 001) -4. 289), TTLVR (P0. 001), before treatment (P0. 001% -4. 289), TTLVR (P0. 001). Rs=-0.385) is a negative correlation factor affecting lipiodol deposition. Conclusion: 1. The independent risk factors influencing the curative effect of TACE were: portal vein tumor thrombus, alkaline phosphatase isozyme 1, tumor volume and lipiodol after treatment. Among them, the amount of lipiodol deposition was the most important risk factor, and different amount of lipiodol deposition resulted in the change of tumor volume. 2. The risk factors affecting lipiodol deposition were: age, tumor size before treatment. 3T plain scan plus enhancement is a common noninvasive follow-up method for evaluating the efficacy of TACE in evaluating the curative effect of hepatocellular carcinoma after treatment, plus the volume of tumor before and after treatment, and the change of tumor volume, (TSR),. The determination of lipiodol deposition rate (LDR) and related laboratory indexes are helpful to evaluate the clinical efficacy of HCC treated with TACE.
【学位授予单位】：四川医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.7
【参考文献】
相关期刊论文 前1条
1 何兰芳;刘燕娜;;超声造影在肝癌介入诊疗中的应用现状及研究进展[J];中国全科医学;2013年26期
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