本文選題：肝細(xì)胞癌 + 經(jīng)肝動(dòng)脈化療栓塞術(shù)　； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:BCLC C期肝細(xì)胞癌治療模式多種多樣,目前我國(guó)還沒有統(tǒng)一的規(guī)范和標(biāo)準(zhǔn)。本文回顧性分析我院BCLC C期肝細(xì)胞癌不同治療模式及預(yù)后影響因素,以探討其最佳治療方法及預(yù)后影響因素。方法:收集2005.01-2012.12在我院首診111例BCLC C期肝細(xì)胞癌患者的臨床資料,按治療方法分為:單純TACE組(n=29)、TACE+索拉非尼組(n=20)、TACE+消融組(n=21)、手術(shù)+TACE組(n=24)、手術(shù)+TACE+消融組(n=17)。采用Kaplan-Meier法進(jìn)行生存分析,運(yùn)用Log-Rank法檢驗(yàn)。運(yùn)用COX風(fēng)險(xiǎn)模型分析影響B(tài)CLC C期肝細(xì)胞癌患者預(yù)后因素。結(jié)果:單純TACE組:中位生存期為16月,1、2、3年生存率為64.7%、22.7%、0%;TACE+索拉非尼組:中位生存期為12月,1、2、3年生存率為46.8%、23.2%、8.8%;TACE+消融組:中位生存期36月,1、2、3年生存率分別為:70%、46.4%、46.4%;手術(shù)+TACE組:中位生存期為21月,1、2、3年生存率分別為:73.7%、73.7%、59.0%。手術(shù)+TACE+消融組:中位生存期19月,1、2、3年生存率分別為:94.1%、94.1%、80.9%。將各組進(jìn)行兩兩比較,結(jié)果示:手術(shù)+TACE+消融組總生存期較單純TACE組、TACE+索拉非尼組和手術(shù)+TACE組高,差異性有統(tǒng)計(jì)學(xué)意義(P0.05),而與TACE+消融組相比無統(tǒng)計(jì)學(xué)差異(P0.05);TACE+消融組總生存期較單純TACE組、TACE+索拉非尼組高,差異性有統(tǒng)計(jì)學(xué)意義(P0.05),而與手術(shù)+TACE組和手術(shù)+TACE+消融相比無統(tǒng)計(jì)學(xué)差異(P0.05);手術(shù)+TACE組總生存期較TACE+索拉非尼組高,差異性有統(tǒng)計(jì)學(xué)意義(P0.05),而與TACE+消融組、單純TACE組相比無統(tǒng)計(jì)學(xué)差異(P0.05);單純TACE組總生存期與TACE+索拉非尼相比,差異性無統(tǒng)計(jì)學(xué)意義(P0.05)。單因素分析結(jié)果顯示:年齡(P=0.028)、腫瘤大體分型(P=0.041)、肝外轉(zhuǎn)移(P=0.010)、腫瘤最大直徑(P=0.008)、治療模式(P=0.000)差異有統(tǒng)計(jì)學(xué)意義。多因素結(jié)果顯示:腫瘤最大直徑、肝外轉(zhuǎn)移、治療模式是影響預(yù)后的獨(dú)立因素。結(jié)論:腫瘤最大徑、肝外轉(zhuǎn)移、治療模式是影響B(tài)CLC C期肝細(xì)胞癌患者預(yù)后的獨(dú)立因素;對(duì)于可手術(shù)切除的BCLC C期肝細(xì)胞癌患者,手術(shù)+TACE+消融治療可延長(zhǎng)患者生存時(shí)間;對(duì)于不能手術(shù)切除BCLC C期肝細(xì)胞癌患者,TACE+消融治療可延長(zhǎng)患者生存時(shí)間;TACE+索拉非尼治療未能顯著延長(zhǎng)BCLC C期肝細(xì)胞癌患者生存時(shí)間,尚需大樣本、多中心、隨機(jī)、雙盲、前瞻性研究來驗(yàn)證。
[Abstract]:Objective: there are many kinds of treatment modes for stage C hepatocellular carcinoma (HCC) in BCLC, but there is no uniform standard and standard in China. In this paper, we retrospectively analyzed the different treatment modes and prognostic factors of BCLC C stage hepatocellular carcinoma (HCC) in order to explore the best treatment method and prognostic factors. Methods: the clinical data of 111 patients with BCLC stage hepatocellular carcinoma (HCC) in our hospital from January to February 2012 were collected and divided into two groups: simple TACE group (n = 29), TACE group (n = 20), TACE ablation group (n = 21), surgical TACE group (n = 24), and surgical TACE ablation group (n = 1717). Kaplan-Meier method was used to analyze survival and Log-Rank method was used to test it. Cox risk model was used to analyze the prognostic factors of patients with BCLC C hepatocellular carcinoma. Results: in the simple TACE group, the median survival time was 16 months, and the 3-year survival rate was 64.7 and 22.77.The median survival time was 12 months and the 3-year survival rate was 46.8 months and 23.28.8cm, respectively. The median survival time was 36 months and the 3-year survival rate was: the mean survival time was 30 months and 46.4.The operative TACE group was the same as the TACE group, and the operative TACE group was the same as the operation TACE group: the median survival time was 36 months and the 3-year survival rate was respectively: 70%, 46.4%, 46.44.The median survival time of the TACE group was 64.7%, and the 3-year survival rate was 64.7%. The median survival time was 21 months / 1 / 2, and the 3 year survival rate was 1 / 73.7and 73.7 / 59.0, respectively. In the TACE ablation group, the median survival time was 19 months and the 3-year survival rate was 1: 94. 1 and 94. 1%, respectively. The results showed that the total survival time of TACE ablation group was longer than that of TACE alone group and operative TACE group. There was no significant difference between TACE ablation group and TACE ablation group. The total survival time of TACE ablation group was higher than that of simple TACE group, and the total survival time of TACE ablation group was higher than that of TACE alone group, but there was no significant difference between TACE ablation group and TACE ablation group. The difference was statistically significant (P 0.05), but there was no significant difference compared with TACE group and TACE ablation group, the total survival time of operation TACE group was higher than that of TACE Solafenil group, the difference was statistically significant (P 0.05), but that of TACE ablation group was higher than that of TACE ablation group. There was no statistical difference between TACE group and TACE group, but there was no significant difference in total survival time between TACE group and TACE group (P 0.05). The results of univariate analysis showed that there were significant differences in age (P < 0.028), gross classification (P < 0.041), extrahepatic metastasis (P = 0.010), maximum diameter of tumor (P = 0.008) and treatment mode (P = 0.000). Multivariate results showed that the maximum diameter of tumor, extrahepatic metastasis and treatment mode were independent factors affecting prognosis. Conclusion: the maximum diameter of tumor, extrahepatic metastasis and treatment mode are independent factors influencing the prognosis of patients with BCLC C hepatocellular carcinoma, and the survival time can be prolonged by TACE ablation for patients with resectable BCLC C hepatocellular carcinoma. TACE ablation can prolong the survival time of patients with BCLC C stage hepatocellular carcinoma. The survival time of patients with BCLC stage hepatocellular carcinoma can not be significantly prolonged by TACE solafenil therapy. Large sample, multi-center, random, double-blind are needed. Prospective studies to verify.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.7

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本文編號(hào)：2005510