原发性肝细胞癌自发性破裂—单中心11年85例RWE生存分析

发布时间：2019-06-05 20:13

【摘要】：背景:肝细胞癌是常见的恶性肿瘤之一,也是肿瘤导致人类死亡的第三大死因。自发性破裂是肝细胞癌需要紧急处理的重要并发症之一。根治性手术仍是破裂肝细胞癌的理想治疗方法。然而,对于那些无法接受根治性手术治疗的患者,肝动脉化疗栓塞(TACE)是治疗肝细胞癌(HCC)的标准方法,以提高近期生存率和改善远期预后。自1992年引入以来,评价两种治疗方法的循证医学的“范式”作为医学学习与实践的新方法仍充满争议[1]。本研究的目的是通过单中心11年肝癌自发破裂病例分析,评估预后的影响因素。其“真实证据”(real-world evidence,RWE)是来自非典型来源的医疗保健信息,包括电子健康记录,计费数据库的产品和疾病登记册,以评估药物和治疗的安全性和有效性[2]。目的:回顾性分析总结五种不同形式治疗肝癌自发破裂出血的总生存率。材料方法:本文收集2005年1月至2015年12月广西医科大学第一附属医院85例临床诊断自发性破裂出血HCC住院病例,其中,10例接受保守治疗(A组);28例接受手术切除(B组);19例患者接受手术切除肿瘤后经动脉化疗栓塞治疗(C组);24例行动脉栓塞化疗(D组)和4例接受分期肝切除术(经动脉化疗栓塞术后行肝切除术)(E组)。本研究回顾性分析了单纯手术切除,单纯TACE,保守治疗,手术切除后行TACE和术前行TACE后手术切除术的临床资料。确定独立预后预测因子做Cox多变量回归生存分析。结果:85例HCC自发性破裂患者1年,2年,3年,4年,5年自发性破裂的HCC的总生存率分别为30.6%,18.8%,14.1%,5。9%和3.5%。在A组(保守治疗组)中,10例患者中位生存时间为1个月(1-6个月)。B组(仅行手术切除术)28例患者中位生存时间为18个月(1-122个月),1年,2年,3年,4年5年生存率分别为42.9%,42.9%,21.4%,10.7%和3.5%。在C组(肝切除术后行TACE组)中,19例患者中位生存时间为24个月(2-90个月)。1年,2年,3年,4年,5年生存率分别为47.4%,42.1%,36.8%,31.5%和5.3%。D组(仅行TACE)24例患者中位生存时间为14个月(1-124个月),1至5年生存率分别为12.5%,4.2%,4.2%,4.2%和4.2%分别。在E组(TACE术后行肝切除)中,由于患者数量很少(仅4例),生存时间的中位数为49个月(5-53个月)。1年,2年,3年,4年,5年生存率分别为50%,25%,25%,25%和25%。多因素Cox回归分析显示,谷草转氨酶水平、饮酒史、肿瘤局部侵犯和术前血清AFP水平对总生存时间有显着影响。结论:血清AFP≥400ng/ml,谷草转氨酶水平升高,饮酒史和局部侵袭性强的自发性破裂肝细胞癌患者预后差。与接受保守治疗的患者相比,更积极的治疗策略可能使自发性破裂肝细胞癌患者获益。
[Abstract]:Background: hepatocellular carcinoma (HCC) is one of the common malignant tumors and the third leading cause of death. Spontaneous rupture is one of the important complications of hepatocellular carcinoma (HCC). Radical surgery is still an ideal treatment for ruptured hepatocellular carcinoma. However, (TACE) is the standard method for the treatment of hepatocellular carcinoma (HCC) in patients who cannot receive radical surgery in order to improve the short-term survival rate and long-term prognosis. Since its introduction in 1992, the "paradigm" of evidence-based medicine, which evaluates the two treatments, as a new method of medical learning and practice, is still controversial [1]. The purpose of this study was to evaluate the prognostic factors by analyzing the spontaneous rupture of liver cancer in 11 years. Its "real evidence" (real-world evidence,RWE) is health care information from atypical sources, including electronic health records, billing database products and disease registers to assess the safety and effectiveness of drugs and treatments [2]. Objective: to analyze and summarize the overall survival rate of five different forms of liver cancer spontaneous rupture and hemorrhage. Materials and methods: from January 2005 to December 2015, 85 cases of HCC diagnosed as spontaneous ruptured bleeding in the first affiliated Hospital of Guangxi Medical University were collected, of which 10 cases were treated conservatively (group A). 28 patients underwent surgical resection (group B), 19 patients received transarterial chemoembolism after surgical resection of tumor (group C), and 19 patients underwent transarterial chemoembolism after surgical resection of tumor (group C). 24 patients underwent arterial chemoembolization (group D) and 4 patients underwent phased hepatectomy () (E group after transarterial chemoembolization). In this study, the clinical data of simple surgical resection, simple TACE, conservative treatment, TACE after surgical resection and post-TACE resection before operation were analyzed retrospectively. the clinical data of simple resection, conservative treatment of TACE, surgical resection after surgical resection and surgical resection after operation were analyzed. Cox multivariate regression survival analysis was performed to determine the independent prognostic factors. Results: the overall survival rates of 85 patients with spontaneous rupture of HCC in 1 year, 2 years, 3 years, 4 years and 5 years were 30.6%, 18.8%, 14.1%, 5.9% and 3.5%, respectively. In group A (conservative treatment group), the median survival time of 10 patients was 1 month (1 鈮，

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