【摘要】：目的:研究術(shù)前肝動脈化療栓塞術(shù)(Transcatheter Arterial Chemoembolization,TACE)壞死程度是否與肝癌患者的遠(yuǎn)期生存率有相關(guān)性。方法:回顧性分析2009年至2016年期間在大連醫(yī)科大學(xué)附屬第二醫(yī)院住院治療的34例原發(fā)性肝癌患者,經(jīng)手術(shù)病理報告均為肝細(xì)胞癌,所有研究對象均選擇TACE作為第一輔助治療方案,序貫TACE后或者至少一次TACE后行手術(shù)治療,TACE采用常規(guī)Seldinger方法,根據(jù)病理結(jié)果我們將術(shù)前TACE腫瘤壞死程度分為完全壞死組肝癌患者和不完全壞死組肝癌患者,并以此將34例例患者分為兩組,即完全壞死組肝癌患者組和不完全壞死組肝癌患者組,完全壞死組肝癌患者為8例,不完全壞死組肝癌患者為26例,同時根據(jù)影像學(xué)表現(xiàn)及WHO世界實體瘤大小評價標(biāo)準(zhǔn)將TACE術(shù)后腫瘤反應(yīng)分為完全緩解、部分緩解、進(jìn)展和穩(wěn)定,用獨立t檢驗分析計量資料及分類變量等一般資料,用Kaplan-Meier生存曲線分析比較完全壞死組肝癌患者和不完全壞死組肝癌患者的無瘤生存期及總生存期。logistic多因素回歸分析影響術(shù)前TACE腫瘤壞死程度的影響因素。結(jié)果:兩組的平均年齡:腫瘤完全壞死組肝癌患者的肝癌患者平均年齡為53.58歲,腫瘤不完全壞死組肝癌患者的肝癌患者平均年齡為51.54歲,差異無顯著性。完全壞死組肝癌患者組肝癌患者的慢性乙型肝炎率為100%,不完全壞死組肝癌患者的慢性乙型肝炎為19例,非乙型肝炎為7例。兩組的Child-Pugh分級均為A級和B級,完全壞死組肝癌患者有一個為B級,不完全壞死組肝癌患者則有2例B級;由于AFP在檢驗結(jié)果中單位的不同,我們僅將其分為正常組及異常組,完全壞死組肝癌患者有2位患者AFP為正常,而不完全壞死組肝癌患者則有14例正常;同樣的我們通過CT、MRI等查看了門脈癌栓情況,完全壞死組肝癌患者有1例患者有門脈癌栓,而不完全壞死組肝癌患者則有4例門脈癌栓,完全壞死組肝癌患者術(shù)前多次TACE的有3例,而不完全壞死組肝癌患者多次TACE的患者有6例,完全壞死組肝癌患者的平均TACE-手術(shù)時間間隔為202.6天,不完全壞死組肝癌患者的平均TACE-手術(shù)時間間隔為114.5天,我們調(diào)查發(fā)現(xiàn),完全壞死組肝癌患者有1例患者為III期,不完全壞死組肝癌患者有6位患者為III期,壞死組的平均腫瘤直徑為3.35cm,不完全壞死組肝癌患者的平均腫瘤直徑為4.058cm,完全壞死組肝癌患者有4例患者在右半肝,4例在左半肝,而不完全壞死組肝癌患者則有19例在右半肝,7例在左半肝。完全壞死組肝癌患者的平均血小板水平為145.85*10^9/L,不完全壞死組肝癌患者的平均血小板水平為150.98*10^9/L;完全壞死組肝癌患者的平均凝血酶原時間為14.11秒,不完全壞死組肝癌患者的平均凝血酶原時間為13.41秒,平均總膽紅素水平在完全壞死組肝癌患者組為17.05umol/L,在不完全壞死組肝癌患者組為17.01umol/L,以上情況在完全壞死組肝癌患者組和不完全壞死組肝癌患者組經(jīng)獨立t檢驗均無顯著差異。肝癌術(shù)前TACE腫瘤完全壞死組肝癌患者的中位無瘤生存期為35.43個月,不完全壞死組肝癌患者的中位無瘤生存期為19.78個月,差異經(jīng)時序檢驗(LogRank test)分析有顯著性(p=0.009),總生存期則無差異。多因素分析發(fā)現(xiàn)腫瘤大小以及是否為多次TACE以及腫瘤反應(yīng)程度均不是腫瘤是否完全壞死的預(yù)測因素。結(jié)論:肝癌患者術(shù)前TACE腫瘤完全壞死的肝癌患者中位無瘤生存期要顯著長于不完全壞死組的肝癌患者,完全壞死組中位總生存期雖然高于術(shù)前TACE不完全壞死組肝癌患者,但是統(tǒng)計學(xué)無差異。
[Abstract]:Objective: To study whether the degree of necrosis of preoperative transcatheter arterial chemoembolization (TACE) is related to the long-term survival rate of patients with hepatocellular carcinoma (HCC). Methods: A retrospective analysis was made of 34 patients with HCC hospitalized in the Second Affiliated Hospital of Dalian Medical University from 2009 to 2016. All patients were treated with TACE as the first adjuvant therapy. After sequential TACE or at least one TACE, TACE was performed with routine Seldinger method. According to the pathological results, the degree of tumor necrosis before TACE was divided into complete necrosis group and incomplete necrosis group. Thirty-four patients were divided into two groups: complete necrosis group and incomplete necrosis group, complete necrosis group and incomplete necrosis group. There were 8 cases of complete necrosis group and 26 cases of incomplete necrosis group. Kaplan-Meier survival curve was used to analyze the tumor-free survival and total survival of patients with complete necrosis and those with incomplete necrosis. Logistic multivariate regression analysis was used to analyze the influencing factors of tumor necrosis before TACE. Results: The average age of the two groups was 53.58 years in the complete necrosis group and 51.54 years in the incomplete necrosis group. The chronic hepatitis B rate was 100% in the complete necrosis group and 100% in the incomplete necrosis group. There were 19 cases of chronic hepatitis B and 7 cases of non-hepatitis B. The Child-Pugh grades of both groups were A and B. One of the patients with complete necrosis and two of the patients with incomplete necrosis were B. Fourteen patients with normal AFP and 14 patients with incomplete necrosis of liver cancer were normal. Similarly, we examined the portal vein tumor thrombus by CT and MRI. One patient with complete necrosis of liver cancer had portal vein tumor thrombus, four patients with incomplete necrosis of liver cancer had portal vein tumor thrombus, and three patients with complete necrosis of liver cancer had multiple TACE before operation. There were 6 patients with multiple TACE in the incomplete necrosis group. The mean TACE-operation time interval was 202.6 days in the complete necrosis group and 114.5 days in the incomplete necrosis group. We found that 1 patient with complete necrosis group had stage III liver cancer and 1 patient with incomplete necrosis group had stage III liver cancer. Six patients had stage III, the average diameter of tumor in necrosis group was 3.35 cm, the average diameter of tumor in incomplete necrosis group was 4.058 cm, four patients in complete necrosis group were in right liver, four patients in left liver, 19 patients in incomplete necrosis group were in right liver, and seven patients in left liver. The mean platelet level was 145.85 * 10 ^ 9 / L in the complete necrosis group, 150.98 * 10 ^ 9 / L in the incomplete necrosis group, 14.11 seconds in the complete necrosis group, 13.41 seconds in the incomplete necrosis group and 13.41 seconds in the complete necrosis group. The median tumor-free survival time was 35.43 months in the TACE group and 35.43 months in the incomplete necrosis group. The median tumor-free survival time of HCC patients was 19.78 months. The difference was statistically significant by LogRank test (p = 0.009), but there was no difference in total survival time. The median tumor-free survival time of patients with complete necrosis was significantly longer than that of patients with incomplete necrosis. Although the median total survival time of patients with complete necrosis was higher than that of patients with TACE incomplete necrosis, the difference was not statistically significant.
【學(xué)位授予單位】：大連醫(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

【參考文獻(xiàn)】

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1 Yi-Xiang J.Wang;Thierry De Baere;Jean-Marc Idee;Sebastien Ballet;;Transcatheter embolization therapy in liver cancer:an update of clinical evidences[J];Chinese Journal of Cancer Research;2015年02期

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本文編號：2181851