摘要
目的探讨术中射频在中国肝癌分期方案(CNLC)Ⅱa~Ⅲa期多发肝癌患者中的疗效。方法回顾性分析兰州大学第一医院2010年1月11日至2017年1月31日收治的CNLCⅡa~Ⅲa期多发肝癌患者的临床资料。根据治疗方式将患者分为肝动脉化疗栓塞(TACE)组、射频消融(RFA)组、TACE联合RFA组和切除联合RFA组。收集4组患者的年龄、性别、原发肿瘤情况及化验检查等资料。采用Kaplan-Meier方法比较4组患者总体生存差异。运用Cox比例风险回归模型分析患者预后影响因素。并进一步根据术前甲胎蛋白(AFP)、肿瘤最大直径、肿瘤数目进行亚组分析。结果共纳入269例患者,其中男194例、女75例,年龄23~84岁(中位年龄58岁)。其中TACE组73例、RFA组70例、TACE联合RFA组69例、切除联合RFA组57例。TACE组1、3、5年生存率分别为43.5%、10.2%和0,RFA组分别为46.3%、17.7%、和0,TACE联合RFA组分别为56.8%、21.5%和2.3%,切除联合RFA组分别为76.5%、38.7%和3.8%,切除联合RFA组患者生存预后最佳(P<0.05)。单因素分析显示,切除联合RFA、肿瘤最大直径<5 cm、无血管侵犯、术前AFP≤400μg/L、总胆红素(TBIL)<34μmol/L(HR=0.784、0.718、0.633、0.846、0.617;均P<0.05)是改善患者总体生存的影响因素。Cox回归模型显示,切除联合RFA、肿瘤最大直径<5 cm、术前AFP≤400μg/L(HR=0.702、0.743、0.647;均P<0.05)是改善患者总体生存的独立影响因素。结论对CNLCⅡa~Ⅲa期多发肝癌患者而言,切除联合RFA是治疗的有效手段,对延长患者的生存时间有着明显优势。在术前AFP≤400μg/L、肿瘤数目<3个和(或)肿瘤最大直径<5 cm的患者中采用切除联合RFA可延长患者生存时间;切除联合RFA、肿瘤<5 cm、术前AFP≤400μg/L是CNLCⅡa~Ⅲa期多发肝癌患者生存预后的独立影响因素。
Objective To investigate the effects of four therapeutic methods in the comprehensive treatment of China liver cancer staging(CNLC)Ⅱa~Ⅲa stage multiple hepatocellular carcinoma.Method A retrospective study was conducted to collect clinical data of patients with multiple hepatocellular carcinoma(CNLC stageⅡa-Ⅲa),who received transhepatic arterial chemoembolization(TACE group,73 cases),radiofrequency ablation(RFA group,70 cases),TACE combined RFA(TACE combined RFA group,69 cases)and surgical resection combined RFA(surgical resection combined RFA group,57 cases)in the First Hospital of Lanzhou University from January 11,2010 to January 31,2017.The general data of age,gender,primary tumor,and laboratory examination were collected.The differences in overall survival rates and the survival rates among stratified subgrouping with different clinical factors between the four groups of patients were compared by the Kaplan-Meier method.Cox proportional hazards regression model analyzed the prognostic factors.Result A total of 269 patients were enrolled and there were 194 males and 59 females with a median age of 58 years ranging from 23 to 84.The TACE group′s 1,3,and 5-year survival rates were 43.5%,10.2%,and 0,respectively.The RFA group were 46.3%,17.7%,and 0,respectively.The TACE combined RFA group were 56.8%,21.5%,and 2.3%,respectively.The surgical resection combined RFA group was 76.5%,38.7%,and 3.8%,respectively.The surgical resection combined RFA group has the best outcome(P<0.05).Univariate analysis showed that surgery combined RFA,tumor diameter<5 cm,no vascular invasion,preoperative AFP≤400μg/L and TB<34μmol/L are protective factors to improve the survival prognosis of patients with CNLCⅡa~Ⅲa stage multiple hepatocellular carcinoma(HR=0.784,0.718,0.633,0.846,0.617;all P<0.05).Multivariate Cox analysis showed that surgery combined RFA,tumor diameter<5 cm,preoperative AFP≤400μg/L were independent risk prognostic factors for CNLCⅡa-Ⅲa stage multiple hepatocellular carcinoma(HR=0.702,0.743,0.64
作者
张金铎
张旭
裴兆吉
岳平
白冰
林延延
孟文勃
李汛
Zhang Jinduo;Zhang Xu;Pei Zhaoji;Yue Ping;Bai Bing;Lin Yanyan;Meng Wenbo;Li Xun(Department of General Surgery,First Hospital of Lanzhou University,Lanzhou 730000,China;First Clinical Medical School of Lanzhou University,Lanzhou,730000,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2021年第28期2195-2202,共8页
National Medical Journal of China
基金
国家自然科学基金(8187103130)
兰州市人才创新创业项目(2018-RC-13)
兰州大学第一医院院内基金(ldyyyn2018-16)。
关键词
癌
肝细胞
肝动脉化疗栓塞术
射频消融
肝切除
预后
Carcinoma,hepatocellular
Transcatheter arterial chemoembolization
Radiofrequency ablation
Liver resection
Survival rate
