150例原发性肝癌的不同治疗手段的临床预后分析.docVIP

150例原发性肝癌的不同治疗手段的临床预后因素分析 研究生 牛永健 导师 包永星教授 新疆医科大学一附院肿瘤中心 [摘要］ 目的：评价目前肝癌的三种常见治疗方法的生存率情况，以进一步探讨原发性肝癌治疗方式的最佳选择。方法： 回顾性分析我院150例原发性肝癌的病历资料，其中，介入组（A组） 62例，行肝动脉插管栓塞化疗（transcatheter hepatic chemo-embolization TACE）；介入加手术组（TACE+surgery TACE+S）（B组）64例，行手术后介入治疗，部分肿块较大的病例先行介入，待分期降级或肿块缩小后再手术治疗，手术行肝叶或肝段切除，介入仍采用肝动脉插管栓塞化疗；介入加放疗组（C组）24例，介入后再行肿块局部三维适形放疗（3-dimensional conformal radiotherapy 3-DCRT)，介入仍采用肝动脉插管栓塞化疗，即TACE+3-DCRT组。率的检验采用列联表χ2检验，生存分析用Kaplan-Meier法,生存率比较采用Log-rank检验。结果：6月、1年、2年、3年生存率：介入组88.7％（55/62）、71％(44/62)、45.2％(20/44)、21.4%(6/28)；介入加手术组100％(64/64)、92.2％(59/64)、72.9％(43/59)、53.2％(25/47)；介入加放疗组100％(24/24)、83.3％(20/24)、60％(12/20)、46.7％(7/15)。三组治疗方法生存率列联表χ2检验均有显著性差异（P0.05）。两两比较四格表χ2检验,A组与B组有显著性差异（P0.05/3=0.0167）; 三组治疗方法生存分析Kaplan-Meier法检验有显著性差异（P=0.001），A、B和C组治疗方法的中位生存时间分别为24.3、43.9和31.6月，两两比较Log-rank检验,A组与B组有显著性差异（P=0.000）。结论：原发性肝癌的治疗在以介入治疗基础上联合手术、放疗等综合治疗较单纯介入治疗的远期生存率明显提高,介入+手术组生存率明显高于其他两组，从生存曲线图来看，三种疗法生存率比较：介入联合手术组＞介入联合放疗组＞单纯介入组。 关键词：肝癌 TACE 综合治疗 生存率 Clinical prognosis analysis with the different treatment modalities for primary liver cancer(PLC):a report of 150 cases Niu Yongjian Bao Yongxing Abstract: objective to evaluate survival rate condition of current three frequent treatment modalities for primary liver cancer,in order to discuss advancedly the best selection about therapy method for liver cancer .Methods: a retrospective analysis of 150 patients of PLC received three frequent treatments our hospital,among them ,62 cases which were included in intervention group were treated with transcatheter hepatic chemo-embolization ( TACE)（A group）;64 cases were in TACE+surgery(TACE+S) (B group),to go on intervention treatment after surgery,or in some cases with larger tumor, to go on intervention treatment before surgery, waiting tumor stage is downgraded,or tumor is contracted. To go on resection of liver lobe or segments of liver, intervention way is still transcatheter hepatic chemo-embol