肝細(xì)胞癌患者根治性切除術(shù)后輔助性經(jīng)皮肝動(dòng)脈化療栓塞與單純栓塞療效的比較研究
發(fā)布時(shí)間：2018-10-09 14:27
【摘要】：目的比較肝細(xì)胞癌(hepatocellular carcinoma,HCC)患者根治性切除術(shù)后輔助性經(jīng)皮肝動(dòng)脈化療栓塞(Transarterial chemoembolization,TACE)與單純經(jīng)皮肝動(dòng)脈栓塞(Transarterial embolization,TAE)對(duì)預(yù)后的作用。方法收集2010年4月至2016年4月期間,在山東省腫瘤醫(yī)院接受根治性切除術(shù)的HCC患者共136例,所有患者術(shù)前均未行其他治療;“根治性切除”的標(biāo)準(zhǔn)依據(jù)2011年中華人民共和國衛(wèi)生部《原發(fā)性肝癌診療規(guī)范》中根治性切除II級(jí)標(biāo)準(zhǔn);所有患者隨訪至2017年2月28日。僅行根治性切除術(shù)的36例患者為A組,根治性切除術(shù)后行輔助性TAE治療的30例患者為B組,根治性切除術(shù)后行輔助性TACE治療的70例患者為C組,根據(jù)患者臨床資料進(jìn)行預(yù)后及影響因素分析。結(jié)果三組患者在性別、年齡分布、腫瘤大小、甲胎蛋白(Alpha fetoprotein,AFP)、肝功能Child-Pugh分級(jí)、白蛋白(Albumin,ALB)、總膽紅素(Total bilirubin,TBIL)、谷丙轉(zhuǎn)氨酶(Alanine aminotransferase,ALT)、谷草轉(zhuǎn)氨酶(Aspartate aminotransferase,AST)、γ-谷氨酰轉(zhuǎn)肽酶(Gamma glutamyl transpeptidase,GGT)等方面均無顯著性差異(P0.05),A組患者巴塞羅那臨床肝癌(Barcelona clinical liver cancer,BCLC)分期相比B組和C組均較晚(P=0.012,P0.001)。A、B、C三組患者的1年、2年、3年總生存(Overall survival,OS)率依次為75.0%、75.0%、75.0%,93.3%、90.0%、86.7%和91.4%、87.1%、78.6%,A組與B組、C組之間1年OS率差異具有統(tǒng)計(jì)學(xué)意義(P=0.044,P=0.017),其余差異無統(tǒng)計(jì)學(xué)意義(P0.05);A、B、C三組患者的1年、2年、3年無復(fù)發(fā)生存(Recurrence-free survival,RFS)率依次為69.4%、63.9%、63.9%,76.7%、66.7%、66.7%和75.7%、68.6%、65.7%,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。Cox回歸分析結(jié)果顯示,腫瘤大小和微血管癌栓是影響術(shù)后復(fù)發(fā)的獨(dú)立危險(xiǎn)因素,也是影響預(yù)后的獨(dú)立危險(xiǎn)因素。結(jié)論1.對(duì)于行根治性切除術(shù)的HCC患者,術(shù)后行輔助性TAE或TACE治療可以改善1年總生存率,但不能改善無復(fù)發(fā)生存率和遠(yuǎn)期總生存率;2.根治性切除術(shù)后行輔助性TAE與TACE的療效沒有差別。
[Abstract]:Objective to compare the prognostic effects of adjuvant percutaneous hepatic artery chemoembolization (Transarterial chemoembolization,TACE) and percutaneous hepatic artery embolization (Transarterial embolization,TAE) in patients with hepatocellular carcinoma (hepatocellular carcinoma,HCC) after radical resection. Methods from April 2010 to April 2016, 136 patients with HCC underwent radical resection in Shandong Cancer Hospital. The standard of "radical resection" was based on the standard of II level in 2011, Ministry of Health of the people's Republic of China. All patients were followed up until February 28, 2017. There were 36 patients with radical resection only in group A, 30 patients with adjuvant TAE after radical resection and 70 patients with adjuvant TACE after radical resection. The prognosis and influencing factors were analyzed according to the clinical data. Results Sex, age distribution, tumor size, alpha-fetoprotein (Alpha fetoprotein,AFP), liver function Child-Pugh grade were measured in the three groups. There was no significant difference in albumin (Albumin,ALB), total bilirubin (Total bilirubin,TBIL), alanine aminotransferase (Alanine aminotransferase,ALT), alanine aminotransferase (Aspartate aminotransferase,AST), 緯 -glutamyl transpeptidase (Gamma glutamyl transpeptidase,GGT). The total survival (Overall survival,OS) rate of 75.0% and 75.0% were 75.0%, 75.0%, 90.033% and 91.4%, 87.1%, 78.6A and 78.6A and B group C respectively, respectively (P 0.05). There was no significant difference in OS rate between group A and group B (P 0.05). (P0.05) there was no significant difference in OS rate between group A and group B (P 0.05). (P 0.05) there was no significant difference in OS rate between group A and group B (P 0.05), and there was no significant difference in OS rate between group A and group B (P 0.05). (P 0.05) there was no significant difference in OS rate between group A and group B (P 0.05). (P 0.05) there was no significant difference in OS rate between group A and group B (P 0.05). The recurrence survival (Recurrence-free survival,RFS) rate was 69.4%, 63.9% and 66.7%, 66.7% and 68.7%, respectively. The difference was not statistically significant (P0.05) .Cox regression analysis showed that there was no significant difference between the two groups. Tumor size and microvascular tumor thrombus are independent risk factors for postoperative recurrence and prognosis. Conclusion 1. For patients with HCC undergoing radical resection, adjuvant TAE or TACE therapy can improve 1-year overall survival rate, but can not improve recurrence free survival rate and long-term overall survival rate. There was no difference between the curative effect of adjuvant TAE and TACE after radical resection.
【學(xué)位授予單位】：濟(jì)南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.7
本文編號(hào)：2259682
[Abstract]:Objective to compare the prognostic effects of adjuvant percutaneous hepatic artery chemoembolization (Transarterial chemoembolization,TACE) and percutaneous hepatic artery embolization (Transarterial embolization,TAE) in patients with hepatocellular carcinoma (hepatocellular carcinoma,HCC) after radical resection. Methods from April 2010 to April 2016, 136 patients with HCC underwent radical resection in Shandong Cancer Hospital. The standard of "radical resection" was based on the standard of II level in 2011, Ministry of Health of the people's Republic of China. All patients were followed up until February 28, 2017. There were 36 patients with radical resection only in group A, 30 patients with adjuvant TAE after radical resection and 70 patients with adjuvant TACE after radical resection. The prognosis and influencing factors were analyzed according to the clinical data. Results Sex, age distribution, tumor size, alpha-fetoprotein (Alpha fetoprotein,AFP), liver function Child-Pugh grade were measured in the three groups. There was no significant difference in albumin (Albumin,ALB), total bilirubin (Total bilirubin,TBIL), alanine aminotransferase (Alanine aminotransferase,ALT), alanine aminotransferase (Aspartate aminotransferase,AST), 緯 -glutamyl transpeptidase (Gamma glutamyl transpeptidase,GGT). The total survival (Overall survival,OS) rate of 75.0% and 75.0% were 75.0%, 75.0%, 90.033% and 91.4%, 87.1%, 78.6A and 78.6A and B group C respectively, respectively (P 0.05). There was no significant difference in OS rate between group A and group B (P 0.05). (P0.05) there was no significant difference in OS rate between group A and group B (P 0.05). (P 0.05) there was no significant difference in OS rate between group A and group B (P 0.05), and there was no significant difference in OS rate between group A and group B (P 0.05). (P 0.05) there was no significant difference in OS rate between group A and group B (P 0.05). (P 0.05) there was no significant difference in OS rate between group A and group B (P 0.05). The recurrence survival (Recurrence-free survival,RFS) rate was 69.4%, 63.9% and 66.7%, 66.7% and 68.7%, respectively. The difference was not statistically significant (P0.05) .Cox regression analysis showed that there was no significant difference between the two groups. Tumor size and microvascular tumor thrombus are independent risk factors for postoperative recurrence and prognosis. Conclusion 1. For patients with HCC undergoing radical resection, adjuvant TAE or TACE therapy can improve 1-year overall survival rate, but can not improve recurrence free survival rate and long-term overall survival rate. There was no difference between the curative effect of adjuvant TAE and TACE after radical resection.
【學(xué)位授予單位】：濟(jì)南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.7
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 ;原發(fā)性肝癌診療規(guī)范(2011年版)[J];臨床肝膽病雜志;2011年11期
，本文編號(hào)：2259682
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