本文選題：肝細(xì)胞癌 + 肝切除�。� 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的探討肝細(xì)胞癌術(shù)后序貫非特異性免疫治療(胸腺法新+白介素-2)的療效及預(yù)后影響因素。方法按照知情同意原則,將2011年1月至2014年12月在廣西壯族自治區(qū)人民醫(yī)院肝膽外科收治符合納入標(biāo)準(zhǔn)的154例肝細(xì)胞癌患者分為三組:單純手術(shù)切除組(A組)57例;手術(shù)+1-3個(gè)療程免疫治療組(B組)53例;手術(shù)+≥4個(gè)療程免疫治療組(C組)44例。采用Kaplan-Meier法分析術(shù)后腫瘤復(fù)發(fā)情況和患者生存情況;Cox比列風(fēng)險(xiǎn)回歸模型分析影響術(shù)后生存的因素。結(jié)果1.A、B、C組術(shù)后中位復(fù)發(fā)時(shí)間分別為25、28和31個(gè)月,三組之間的差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.484)。術(shù)后1、3、5年的累積復(fù)發(fā)率分別為32.1%、65.2%和87.1%;29.9%、56.6%和81.3%;26.1%、53.7%和77.5%;術(shù)后1、3、5年的累積生存率分別為79.7%、50.3%和20.0%;90.1%、69.9%和38.8%;92.7%、71.1%和41.5%。2.A、B、C組中位生存時(shí)間分別為41、47和49個(gè)月,三組之間的差異有統(tǒng)計(jì)學(xué)意義(P=0.023),兩兩比較,A組與B組、A組與C組的差異均有統(tǒng)計(jì)學(xué)意義(P=0.042和P=0.015),而B(niǎo)組與C組之間的差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.649)。3.單因素分析顯示腫瘤分化程度、腫瘤直徑、巴塞羅那分期、術(shù)前AFP水平是影響肝癌術(shù)后生存的預(yù)后因素(P0.05);多因素分析顯示腫瘤分化程度是影響肝癌術(shù)后生存的獨(dú)立危險(xiǎn)因素(P=0.044)。結(jié)論肝細(xì)胞癌術(shù)后序貫胸腺法新聯(lián)合IL-2非特異性免疫治療可以延長(zhǎng)生存時(shí)間,其療效可能與免疫治療的療程數(shù)呈正相關(guān),腫瘤分化程度是影響術(shù)后生存的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective to investigate the efficacy and prognostic factors of sequential nonspecific immunotherapy (SNS) for hepatocellular carcinoma (HCC). Methods according to the principle of informed consent, 154 patients with hepatocellular carcinoma treated in the Department of Hepatobiliary surgery, Guangxi Zhuang Autonomous region people's Hospital, from January 2011 to December 2014, were divided into three groups: group A, simple surgical resection, group A, 57 cases; There were 53 cases in Group B and 44 cases in Group C in Group B and Group C respectively. Kaplan-Meier method was used to analyze the recurrence and survival of the patients. Results 1. The median recurrence time of group A was 2528 and 31 months, respectively. There was no significant difference among the three groups (P < 0. 484). The cumulative recurrence rates were 32.2% and 87.1%, and 56.6% and 81.3%, respectively, and 53.7% and 77.5%, respectively. The cumulative survival rates were 79.70.3% and 20.090.1%, 69.9% and 20.090.1% and 38.87.71.1% and 41.5%, 41.5% and 49 months, respectively. The difference among the three groups was statistically significant (P 0.023). There were significant differences between group A and group B (P 0.042) and group C (P 0.015), but there was no significant difference between group B and group C (P 0.649). Univariate analysis showed that tumor differentiation degree, tumor diameter, Barcelona stage and AFP level before operation were the prognostic factors for the survival of HCC after operation, and multivariate analysis showed that the degree of tumor differentiation was an independent risk factor for the survival of HCC after operation. Conclusion Sequential thymus therapy combined with IL-2 nonspecific immunotherapy can prolong the survival time after operation for hepatocellular carcinoma. The curative effect may be positively correlated with the number of courses of immunotherapy. The degree of tumor differentiation is an independent risk factor for postoperative survival.
【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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