摘要
目的分析索拉非尼联合经肝动脉化疗栓塞术(TACE)和射频消融(RFA)治疗肝细胞癌(HCC)患者的生存期及预后影响因素。方法回顾性分析2012年1月-2016年6月首都医科大学附属北京佑安医院收治的,分别接受索拉非尼单药治疗(n=30)、索拉非尼联合TACE(二联疗法,n=70),或者索拉非尼联合TACE和RFA(三联疗法,n=121)治疗的221例HCC患者的中位生存期及其预后影响因素。采用Kaplan-Meier法绘制生存曲线,log-rank检验生存曲线是否有差异,Cox比例风险回归模型进行生存率的影响因素分析;不同疗法治疗患者的Child-Pugh分级和BCLC分期比较,采用Wilcoxon秩和检验分析。结果接受三联疗法治疗患者的中位生存时间,较二联疗法(9. 5个月vs 4. 3个月,χ2=12. 77,P=0. 000 4),或索拉非尼单药治疗组(9. 5个月vs2. 0个月,χ2=16. 69,P <0. 000 1)显著延长。影响疾病进展的危险因素包括患者年龄<60岁,BCLC分期C期,Child-Pugh分级B级、C级,血清AFP> 200 ng/ml,肿瘤低分化,肿瘤直径> 5 cm,有微血管侵犯(MVI)或有肝外转移(EHS)的肝内肿瘤,以及未出现索拉非尼相关副作用(P值均<0. 05)。结论索拉非尼联合TACE和RFA治疗可延长HCC患者的生存期。年龄<60岁和肿瘤负荷严重是影响HCC患者疾病进展的不良预后因素。
Objective To analyze the effect of sorafenib combined with transcatheter arterial chemoembolization( TACE) and radiofrequency ablation( RFA) on the survival of patients with hepatocellular carcinoma( HCC) and its prognostic factors. Methods A retrospective analysis was performed on 221 HCC patients who received sorafenib alone( group A),sorafenib plus TACE( group B),or sorafenib combined with TACE and RFA( group C) in Beijing YouAn Hospital,Capital Medical University,from January 2012 to June 2016 to investigate their median survival and its prognostic factors. The Kaplan-Meier method was used to plot a survival curve,and the log-rank test was used to test whether there was any difference in the survival curve; the Cox proportional-hazards regression model was used to analyze the influencing factors for survival rate; the Wilcoxon rank sum test was used to compare Child-Pugh class and Barcelona Clinic Liver Cancer( BCLC) stage between the patients treated with different therapies. Results Group C had a significantly longer median survival than group B( 9. 5 months vs 4. 3 months,χ^2= 12. 77,P = 0. 000 4) and group A( 9. 5 months vs 2. 0 months,χ^2= 16. 69,P < 0. 000 1). The risk factors for disease progression were age < 60 years,BCLC stage C,Child-Pugh class B,Child-Pugh class C,serum alpha-fetoprotein >200 ng/ml,poor tumor differentiation,tumor diameter > 5 cm,and intrahepatic tumor with microvascular invasion or extrahepatic spread,as well as absence of sorafenib-related side events( all P < 0. 05). Conclusion Sorafenib combined with TACE and RFA can prolong the survival of HCC patients. Age < 60 years and severe tumor burden are poor prognostic factors for disease progression in HCC patients.
作者
孙斌
杨晓珍
谢放
庞丽君
陈德喜
王延军
SUN Bin;YANG Xiaozhen;XIE Fang(Center of Interventional Oncology and Liver Diseases,Beijing YouAn Hospital,Capital Medical University,Beijing 100069,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2019年第1期104-108,共5页
Journal of Clinical Hepatology
基金
北京市科技计划首都市民健康培育项目(Z141100002114002)
北京市卫生系统高层次卫生技术人才资助项目(2014-3-092)
北京市肝病研究所科研基金项目(2018-4-6)
关键词
癌
肝细胞
化学栓塞
治疗性
导管消融术
索拉非尼
carcinoma,hepatocellular
chemoembolization,therapeutic
catheter ablation
sorafenib
