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ABCR评分系统对经肝动脉化疗栓塞术治疗肝细胞癌预后的评估价值
Value of ABCR scoring system in assessing the prognosis of hepatocellular carcinoma after transcatheter arterial chemoembolization
文章发布日期:2020年08月22日  来源:  作者:杨俊,印于,倪才方,等  点击次数:631次  下载次数:35次

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【摘要】:目的 评估ABCR评分系统对肝细胞癌患者再次TACE治疗的指导价值,并探讨ABCR评分为1~3分患者的治疗策略。方法 选取2008年1月-2017年12月在苏州大学附属第一医院行TACE治疗的肝细胞癌患者。为研究不同ABCR分值患者再次TACE治疗的有效性,选取连续行TACE治疗(至少2次,且不联合全身系统治疗)的229例患者为A组,并分为A1组(ABCR评分≤0,n=92)、A2组(ABCR评分:1~3分,n=78)和A3组(ABCR评分≥4,n=59);为研究ABCR评分为1-3分患者首次TACE治疗后接受不同治疗方案的生存期,选取首次行TACE治疗的ABCR评分为1~3分的118例患者为B组,分为B1组(首次TACE后继续TACE,n=78)、B2组(TACE联合索拉非尼,n=21)和B3组(索拉非尼单药治疗,n=19)。分析以上各组患者的生存情况。计数资料组间比较采用Fisher精确检验,Kaplan-Meier法绘制生存曲线,log-rank检验比较各组生存期。结果 A1组中位生存期32.0个月(95%CI:27.7~36.3);A2组中位生存期10.3个月(95%CI:8.4~12.2);A3组中位生存期4.6个月(95%CI:3.7~5.5)。A1组生存期优于A2组(χ2=106.99,P<0.01),A2组生存期优于A3组(χ2=49.66,P<0.01)。B1组中位生存期10.3个月(95%CI:8.4~12.2),B2组中位生存期14.8个月(95%CI:7.8~21.8),B3组中位生存期6.0个月(95%CI:4.6~7.4),B2组生存期优于B1组(χ2=6.80,P<0.01)和B3组(χ2=29.89,P<0.01)。结论 ABCR评分对肝细胞癌患者的治疗有一定指导意义,ABCR评分≤0,可考虑继续TACE治疗;评分≥4,TACE治疗可能无法使患者获益;评分为1~3,TACE联合索拉非尼可能使患者生存期获益最大。
【Abstract】:Objective To investigate the value of ABCR clinical scoring system in guiding repeated transcatheter arterial chemoembolization (TACE) therapy for patients with hepatocellular carcinoma (HCC) and the treatment strategies for patients with an ABCR score of 1-3. Methods The patients with HCC who underwent TACE in The First Affiliated Hospital of Soochow University from January 2008 to December 2017 were enrolled. In order to investigate the effect of repeated TACE in patients with different ABCR scores, 229 patients who underwent repeated TACE consecutively (at least twice, without systemic therapy) were enrolled as group A, which was further divided into group A1 with 92 patients (an ABCR score of ≤0), group A2 with 78 patients (an ABCR score of 1-3), and group A3 with 59 patients (an ABCR score of ≥4). In order to investigate the survival time of patients with an ABCR score of 1-3 who received different regimens after first TACE therapy, 118 patients with an ABCR score of 1-3 who received TACE for the first time were enrolled as group B, which was further divided into group B1 with 78 patients (treated with TACE after first TACE therapy), group B2 with 21 patients (treated with TACE combined with sorafenib), and group B3 with 19 patients (treated with sorafenib alone). The survival of the above groups of patients were analyzed. The Fisher’s exact test was used for comparison of categorical data between groups, the Kaplan-Meier method was used to plot survival curves, and the log-rank test was used for comparison of survival time between groups. Results The median survival time was 320 months (95% confidence interval [CI]: 27.7-36.3) in group A1, 10.3 months (95%CI: 8.4-12.2) in group A2, and 4.6 months (95%CI: 3.7-5.5) in group A3. Group A1 had a better survival time than group A2 (χ2=106.99, P<0.01), and group A2 had a better survival time than group A3 (χ2=49.66, P<0.01). The median survival time was 10.3 months (95%CI: 8.4-12.2) in group B1, 14.8 months (95%CI: 7.8-21.8) in group B2, and 6.0 months (95%CI: 4.6-7.4) in group B3, and group B2 had a better survival time than group B1 (χ2=6.80, P<0.01) and group B3 (χ2=29.89, P<0.01). Conclusion The ABCR score has a certain guiding significance for the treatment of HCC patients. Repeated TACE may be considered for patients with an ABCR score of ≤0, while patients with an ABCR score of ≥4 may not benefit from further TACE therapy, and TACE combined with sorafenib might bring maximum benefits to patients with an ABCR score of 1-3.
【关键字】:癌,肝细胞; 化学栓塞,治疗性; ABCR评分; 索拉非尼
【Key words】:carcinoma,hepatocellular; chemoembolization,therapeutic; ABCR score; sorafenib
【引证本文】:YANG J, YIN Y, NI CF, et al. Value of ABCR scoring system in assessing the prognosis of hepatocellular carcinoma after transcatheter arterial chemoembolization[J]. J Clin Hepatol, 2020, 36(9): 1980-1984. (in Chinese)
杨俊, 印于, 倪才方, 等. ABCR评分系统对经肝动脉化疗栓塞术治疗肝细胞癌预后的评估价值[J]. 临床肝胆病杂志, 2020, 36(9): 1980-1984.

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