原发性肝癌经肝动脉栓塞化疗术后预后指标多因素分析.docVIP

原发性肝癌经肝动脉栓塞化疗术后预后指标多因素分析 　 作者：张成武，赵大建，胡智明，吴伟顶，张宇华 【摘要】 目的 探讨影响无法手术切除原发性肝癌经肝动脉栓塞化疗（transarterial chemoembolization，TACE)术后预后的独立因素。方法 回顾性分析163例行TACE治疗的无法手术切除原发性肝癌患者的临床资料。结果 全组均获随访，随访时间为12～63月，平均为（21.8±27.3）月。总体患者TACE术后的1、3、5年累积生存率分别为69.75%、37.49%和21.84％。单因素分析显示，TNM分期、癌灶个数、肿瘤有无假包膜、病灶分布情况、肿瘤大小、门静脉癌栓情况、血清AFP状态、Child-Pugh分级、肿瘤碘油沉积情况及治疗次数与TACE术后生存率显著相关(P均lt;0.05)；经Cox多因素回归分析得出影响肝癌患者TACE术后长期生存的独立预后因素依次为：Child-Pugh分级、术后碘油沉积情况、门静脉癌栓。结论 Child-Pugh分级、术后碘油沉积分型及门静脉癌栓是影响TACE术后肝癌患者的独立预后因素。 【关键词】 癌，肝细胞；经肝动脉栓塞化疗；预后 Abstact Objecive To evaluate the independent prognostic factors for unresectable hepatocellular carcinoma after transarterial chemoembolization(TACE). Methods The clinical data of 163 patients with unresectable hepatocellular carcinomas who underwent TACE were analyzed retrospectively. Results All of the patients were followed up， and the follow-up time ranged from 12 months to 63 months with mean time of （21.8±27.3）months. The cumulative survival rates of 1， 3 and 5-year after TACE was 69.75%， 37.49% and 21.84％, respectively. The TNM staging， number of lesions， pseudocapsula status， distribution of tumors， size of tumors， portal vein thrombosis of cancer， serum AFP， Child-Pugh grade， lipiodol sinking status and therapeutic number were significantly correlated with survival rates by univariate analysis(all Plt;0.05). Cox multivariate regression analysis revealed that Child-Pugh grade， lipiodol sinking status and portal vein thrombosis of cancer were the independent prognostic factors of long-term survival for patients with unresectable liver cancers after TACE. Conclusions Child-Pugh grade， lipiodol sinking status and portal vein thrombosis of cancer are the independent prognostic factors for unresectable hepatocellular carcinoma after TACE. Keywords carcinoma， hepatocellular； transarterial chemoembolization； prognosis 75％～80％的原发性肝癌患者诊断时已不能手术切除[1]，经肝动脉栓塞化疗（transarterial chemoembolization，TACE）是肝癌患者非手术治疗的主要手段。研究表明诸多因素影响TACE治疗肝癌的效果及预后，但各家结论尚不一致[2-4]。对影响原发性肝癌TACE术后预后因素的分析