本文選題：原發(fā)性肝癌 + TACE��； 參考：《寧夏醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的通過對杭州標準在寧夏地區(qū)肝癌切除術(shù)后行輔助性肝動脈栓塞化療(TACE)的臨床效果進行分析,探討杭州標準對肝癌切除術(shù)后行輔助性TACE治療臨床病例選擇的指導(dǎo)意義。方法查閱寧夏醫(yī)科大學(xué)總醫(yī)院肝膽外科在2008年1月至2013年12月間行肝癌切除術(shù)并術(shù)后病理報告為肝細胞性肝癌患者的病例資料,收集臨床資料齊全的患者274例,其中108例患者僅單純行手術(shù)治療,166例患者術(shù)后行預(yù)防性TACE治療。根據(jù)患者行TACE的次數(shù),分為未行TACE組、一次TACE組、兩次TACE組及多次TACE組,對比患者術(shù)后1、2、3年的無瘤生存率及總生存率,探討預(yù)防性TACE在不同患者群體中的效果。采用Kaplan-Meier法將肝切除術(shù)后的預(yù)后相關(guān)危險因素及術(shù)后無瘤生存率、總體生存率進行單因素分析,受試者工作特征曲線對診斷精度進行預(yù)測。結(jié)果用Kaplan-Meier生存分析顯示杭州標準及TNM分期對肝癌切除術(shù)后患者的預(yù)后都能進行預(yù)測,而杭州標準的預(yù)測能力比TNM分期明顯要高。分別采用TNM分期和杭州標準對術(shù)后復(fù)發(fā)做預(yù)測分析,繪制ROC曲線,結(jié)果顯示TNM分期對術(shù)后腫瘤復(fù)發(fā)預(yù)測的曲線下面積(AUC)為0.614,95%CI為0.547~0.681;杭州標準對術(shù)后腫瘤復(fù)發(fā)預(yù)測的AUC為0.694,95%CI為0.633~0.756;由此可見,杭州標準對肝癌術(shù)后復(fù)發(fā)的預(yù)測能力好于TNM分期,其差異有統(tǒng)計學(xué)意義(Z=1.733,p=0.042)。對于符合杭州標準的患者,四組的1年、2年、3年無瘤生存率分別為85.34%、72.41%、57.76%;77.50%、57.50%、47.50%;76.19%、52.38%、47.62%;85.71%、57.14%、42.86%。1年、2年、3年總生存率分別為97.41%、89.66%、65.52%;92.50%、87.50%、80.00%;96.48%、71.43%、52.38%;100%、92.86%、57.14%。四組患者間的臨床病例數(shù)據(jù)具有可比性,但無瘤生存率及總生存率無統(tǒng)計學(xué)差異(所有的P0.05)。對于超出杭州標準的患者,四組的1年、2年、3年無瘤生存率分別為66.00%、10.00%、6.00%;73.33%、40.00%、40.00%;69.23%、38.46%、23.08%;85.71%、71.43%、42.86%。1年、2年、3年總生存率分別為86.00%、46.00%、24.00%;93.33%、66.67%、40.00%;84.62%、69.23%、53.85%;100%、85.71%、57.14%。四組臨床病例數(shù)據(jù)也具有可比性,其中未行TACE組比其他三組的無瘤生存率及總生存率都低(所有的P值0.05)。然而,行TACE組之間的無瘤生存率與總生存率無明顯差異(所有的P值均0.05)。結(jié)論1、杭州標準及TNM分期對肝癌切除術(shù)后患者的預(yù)后都能進行預(yù)測,而杭州標準的預(yù)測能力比TNM分期明顯要高。2、符合杭州標準的患者肝癌根治性切除術(shù)后行輔助性TACE治療的臨床療效要好于超出杭州標準的患者。因此,杭州標準可以用來指導(dǎo)寧夏地區(qū)輔助性TACE治療的臨床病例選擇。3、超出杭州標準的患者建議行一次輔助性TACE治療可防治術(shù)后腫瘤的復(fù)發(fā),提高術(shù)后遠期生存率。多次TACE治療并不能使該類患者的無瘤生存期及總生存期得到明顯的改善。
[Abstract]:Objective to analyze the clinical effect of TACE-assisted hepatic artery chemoembolization (TACE-TACE) after resection of hepatocellular carcinoma (HCC) in Ningxia area, and to explore the guiding significance of Hangzhou standard in the selection of clinical cases of TACE after hepatectomy. Methods from January 2008 to December 2013, patients with hepatocellular carcinoma (HCC) were treated by hepatobiliary surgery in General Hospital of Ningxia Medical University. 274 patients with HCC were collected. One hundred and eight patients received only surgical treatment and 166 patients received prophylactic TACE after operation. According to the times of TACE, the patients were divided into three groups: no TACE group, one TACE group, two TACE group and multiple TACE group. The tumor-free survival rate and the overall survival rate were compared between 1 and 3 years after operation, and the effect of prophylactic TACE in different patient groups was discussed. Kaplan-Meier method was used to analyze the prognostic risk factors, tumor free survival rate and overall survival rate after hepatectomy. The diagnostic accuracy was predicted by the operating characteristic curve. Results Kaplan-Meier survival analysis showed that both Hangzhou criteria and TNM staging could predict the prognosis of patients after hepatectomy, but Hangzhou criteria had higher predictive power than TNM staging. TNM staging and Hangzhou standard were used to predict postoperative recurrence, and ROC curves were drawn. The results showed that the area under the curve of TNM staging for predicting postoperative tumor recurrence was 0.614 ~ (95) CI was 0.547 ~ (0.681), and the AUC of Hangzhou standard for postoperative tumor recurrence was 0.633 ~ 0.756. It can be seen that Hangzhou standard is better than TNM stage in predicting postoperative recurrence of liver cancer. The difference was statistically significant. For those patients who meet the Hangzhou standard, the one-year, 2-year and 3-year tumor-free survival rates of the four groups were 85.34 and 72.41and 57.507.507.5077.5077.5077.5077.50A, respectively. They were involved in the work of 47.507.5076.1976.197.52.380.The total survival rate of the four groups was 97.411,89.65.29.5087.5087.50 and 80.0096.488.4851.4351.4352.3852.3852.3857.450.The overall survival rate was 97.411,89.6665.5292.5087.5057.57.57.57.140.The overall survival rate was 97.4116.65.29.50% 87.500.87.47.47.47.450.The overall survival rate of the four groups was 87.411and 87.500.57.47.500.The total survival rate was 87.441. The clinical data of the four groups were comparable, but there was no significant difference in tumor free survival rate and overall survival rate (all P 0.05). For those patients exceeding the Hangzhou standard, the one-year, 2-year and 3-year tumor-free survival rates of the four groups were 66.00 and 10.00 respectively. 73.336.00 and 40.0040.0040.0040.0040.0040.0040.0040.0040.0040.0040.0040.0040.0040.0040.0040.0040.0040.0049.2338.460.The total survival rate of the patients in the four groups was 86.00, 46.00 and 24.000.The overall survival rate was 66.00, 10.00 and 6.00 respectively. It was 79.238.40.0040.0040.0040.0040.0040.0040.0049.238.468.085.710.The total survival rate for the four groups was 86.00, 46.00 and 24.000.The total survival rate for the four groups was 66.00, 10.00 and 6.00, respectively. The clinical data of the four groups were also comparable. The tumor-free survival rate and overall survival rate of the non-TACE group were lower than those of the other three groups (all P values were 0.05). However, there was no significant difference in tumor-free survival rate and overall survival rate between TACE groups (all P values were 0.05). Conclusion 1.Hangzhou standard and TNM staging can predict the prognosis of patients after hepatectomy. The predictive ability of Hangzhou standard was significantly higher than that of TNM staging, and the clinical efficacy of adjuvant TACE after radical resection of hepatocellular carcinoma was better than that of patients beyond Hangzhou standard. Therefore, Hangzhou standard can be used to guide the clinical case selection of adjuvant TACE treatment in Ningxia area. The patients who exceed Hangzhou standard suggest that one time auxiliary TACE therapy can prevent the recurrence of postoperative tumor and improve the long-term survival rate. Multiple TACE therapy did not significantly improve the tumor-free survival and total survival of these patients.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.7

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