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BCLC分期C期肝细胞癌不同治疗方案的效果及预后影响因素分析
Clinical effects of different treatment regimens for Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma and influencing factors for prognosis
文章发布日期:2018年08月06日  来源:  作者:陆冬玲,朱玉平,欧杰,等  点击次数:457次  下载次数:31次

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【摘要】:目的分析巴塞罗那肝癌临床分期(BCLC) C期肝细胞癌(HCC)的不同治疗方案及预后影响因素。方法回顾性分析2005年1月-2012年12月在广西医科大学附属肿瘤医院首次诊断并治疗的BCLC C期HCC患者的临床资料。按照治疗方案分为:单纯经肝动脉化疗栓塞术(TACE)组(n=20)、TACE+索拉非尼组(n=18)、TACE+消融组(n=17)、手术+TACE组(n=20)、手术+TACE+消融组(n=16)。随访并记录患者生存状况及具体死亡时间,比较各组生存期。计数资料组间比较采用χ2检验,计量资料组间比较采用方差分析;采用Kaplan-Meier绘制总生存率曲线,采用log-rank比较累积生存率,采用Cox回归模型行单因素、多因素分析。结果共纳入HCC患者91例,随访终止日期为2016年11月1日,随访率为100%。单因素分析结果显示,年龄、肝外转移、肿块类型、肿瘤最大直径、治疗方案等是BCLC C期HCC预后的影响因素(P值均<0.05)。多因素结果显示,年龄(P=0.019)、肿瘤最大直径(P=0.018)、肝外转移(P=0.026)、治疗方案(P=0.006)是HCC预后的独立影响因素。不同方案治疗的BCLC C期HCC患者总生存期差异有统计学意义(χ2=22.841,P<0001)。其中,手术+TACE+消融组总生存期明显高于其他4组(P值均<0.05);TACE+消融组总生存期明显高于单纯TACE组、TACE+索拉非尼组(P值均<0.05);手术+TACE组的总生存期明显高于单纯TACE组、TACE+索拉非尼组(P值均<0.05)。结论年龄、肿瘤最大直径、肝外转移、治疗方案是影响BCLC C期HCC预后的独立影响因素。可切除的BCLC C期HCC应首选手术治疗,术后予TACE预防复发;复发后病灶继续予TACE或消融治疗,若有机会可再次行外科切除;不可手术切除的BCLC C期HCC首选TACE联合消融治疗,二者可优势互补,提高总生存期。
【Abstract】:ObjectiveTo investigate the clinical effects of different treatment regimens for Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) and influencing factors for prognosis. MethodsA retrospective analysis was performed for the clinical data of 91 patients with BCLC stage C HCC who were diagnosed and treated in The Affiliated Tumor Hospital of Guangxi Medical University from January 2005 to December 2012. According to the treatment regimen, these patients were divided into transarterial chemoembolization (TACE) group with 20 patients, TACE+sorafenib group with 18 patients, TACE+ablation group with 17 patients, surgery+TACE group with 20 patients, and surgery+TACE+ablation group with 16 patients. The patients were followed up to record survival and death time, and survival time was compared between groups. The chi-square test was used for comparison of categorical data between groups, and an analysis of variance was used for comparison of continuous data between groups. The Kaplan-Meier method was used to plot overall survival curves, and the log-rank test was used for comparison of cumulative survival rates. The Cox regression model was used for univariate and multivariate analyses. ResultsA total of 91 HCC patients were enrolled, and follow-up ended on November 1, 2016, with a follow-up rate of 100%. The univariate analysis showed that age, extrahepatic metastasis, tumor type, maximum tumor diameter, and treatment regimen were influencing factors for the prognosis of BCLC stage C HCC (all P<0.05), and the multivariate analysis showed that age (P=0019), maximum tumor diameter (P=0.018), extrahepatic metastasis (P=0.026), and treatment regimen (P=0.006) were independent influencing factors for the prognosis of HCC. There was a significant difference in overall survival between groups (χ2=22.841, P<0001). The surgery+TACE+ablation group had a significantly longer overall survival time than the other four groups (all P<0.05); the TACE+ablation group had a significantly longer overall survival time than the TACE group and the TACE+sorafenib group (P<0.05); the surgery+TACE group had a significantly longer overall survival time than the TACE group and the TACE+sorafenib group (P<0.05). ConclusionAge, maximum tumor diameter, extrahepatic metastasis, and treatment regimen are independent influencing factors for the prognosis of BCLC stage C HCC. Surgical treatment should be selected for resectable stage C HCC, and TACE should be performed after surgery to prevent recurrence. TACE or ablation should be performed after recurrence, and surgical resection can be performed again when possible. TACE combined with ablation should be performed for unresectable stage C HCC, and the advantages of these two treatment methods can improve overall survival time.
【关键字】:癌, 肝细胞; 化学栓塞, 治疗性; 导管消融术; 索拉非尼; 预后; 危险因素
【Key words】:carcinoma, hepatocellular; chemoembolization, therapeutic; catheter ablation; sorafenib; prognosis; risk factors
【引证本文】:LU DL, ZHU YP, OU J, et al. Clinical effects of different treatment regimens for Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma and influencing factors for prognosis[J]. J Clin Hepatol, 2018, 34(9): 1905-1910. (in Chinese)
陆冬玲, 朱玉平, 欧杰, 等. BCLC分期C期肝细胞癌不同治疗方案的效果及预后影响因素分析[J]. 临床肝胆病杂志, 2018, 34(9): 1905-1910.

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