【摘要】：背景:肝細胞癌是常見的惡性腫瘤之一,也是腫瘤導(dǎo)致人類死亡的第三大死因。自發(fā)性破裂是肝細胞癌需要緊急處理的重要并發(fā)癥之一。根治性手術(shù)仍是破裂肝細胞癌的理想治療方法。然而,對于那些無法接受根治性手術(shù)治療的患者,肝動脈化療栓塞(TACE)是治療肝細胞癌(HCC)的標準方法,以提高近期生存率和改善遠期預(yù)后。自1992年引入以來,評價兩種治療方法的循證醫(yī)學(xué)的“范式”作為醫(yī)學(xué)學(xué)習(xí)與實踐的新方法仍充滿爭議[1]。本研究的目的是通過單中心11年肝癌自發(fā)破裂病例分析,評估預(yù)后的影響因素。其“真實證據(jù)”(real-world evidence,RWE)是來自非典型來源的醫(yī)療保健信息,包括電子健康記錄,計費數(shù)據(jù)庫的產(chǎn)品和疾病登記冊,以評估藥物和治療的安全性和有效性[2]。目的:回顧性分析總結(jié)五種不同形式治療肝癌自發(fā)破裂出血的總生存率。材料方法:本文收集2005年1月至2015年12月廣西醫(yī)科大學(xué)第一附屬醫(yī)院85例臨床診斷自發(fā)性破裂出血HCC住院病例,其中,10例接受保守治療(A組);28例接受手術(shù)切除(B組);19例患者接受手術(shù)切除腫瘤后經(jīng)動脈化療栓塞治療(C組);24例行動脈栓塞化療(D組)和4例接受分期肝切除術(shù)(經(jīng)動脈化療栓塞術(shù)后行肝切除術(shù))(E組)。本研究回顧性分析了單純手術(shù)切除,單純TACE,保守治療,手術(shù)切除后行TACE和術(shù)前行TACE后手術(shù)切除術(shù)的臨床資料。確定獨立預(yù)后預(yù)測因子做Cox多變量回歸生存分析。結(jié)果:85例HCC自發(fā)性破裂患者1年,2年,3年,4年,5年自發(fā)性破裂的HCC的總生存率分別為30.6%,18.8%,14.1%,5。9%和3.5%。在A組(保守治療組)中,10例患者中位生存時間為1個月(1-6個月)。B組(僅行手術(shù)切除術(shù))28例患者中位生存時間為18個月(1-122個月),1年,2年,3年,4年5年生存率分別為42.9%,42.9%,21.4%,10.7%和3.5%。在C組(肝切除術(shù)后行TACE組)中,19例患者中位生存時間為24個月(2-90個月)。1年,2年,3年,4年,5年生存率分別為47.4%,42.1%,36.8%,31.5%和5.3%。D組(僅行TACE)24例患者中位生存時間為14個月(1-124個月),1至5年生存率分別為12.5%,4.2%,4.2%,4.2%和4.2%分別。在E組(TACE術(shù)后行肝切除)中,由于患者數(shù)量很少(僅4例),生存時間的中位數(shù)為49個月(5-53個月)。1年,2年,3年,4年,5年生存率分別為50%,25%,25%,25%和25%。多因素Cox回歸分析顯示,谷草轉(zhuǎn)氨酶水平、飲酒史、腫瘤局部侵犯和術(shù)前血清AFP水平對總生存時間有顯著影響。結(jié)論:血清AFP≥400ng/ml,谷草轉(zhuǎn)氨酶水平升高,飲酒史和局部侵襲性強的自發(fā)性破裂肝細胞癌患者預(yù)后差。與接受保守治療的患者相比,更積極的治療策略可能使自發(fā)性破裂肝細胞癌患者獲益。
[Abstract]:Background: hepatocellular carcinoma (HCC) is one of the common malignant tumors and the third leading cause of death. Spontaneous rupture is one of the important complications of hepatocellular carcinoma (HCC). Radical surgery is still an ideal treatment for ruptured hepatocellular carcinoma. However, (TACE) is the standard method for the treatment of hepatocellular carcinoma (HCC) in patients who cannot receive radical surgery in order to improve the short-term survival rate and long-term prognosis. Since its introduction in 1992, the "paradigm" of evidence-based medicine, which evaluates the two treatments, as a new method of medical learning and practice, is still controversial [1]. The purpose of this study was to evaluate the prognostic factors by analyzing the spontaneous rupture of liver cancer in 11 years. Its "real evidence" (real-world evidence,RWE) is health care information from atypical sources, including electronic health records, billing database products and disease registers to assess the safety and effectiveness of drugs and treatments [2]. Objective: to analyze and summarize the overall survival rate of five different forms of liver cancer spontaneous rupture and hemorrhage. Materials and methods: from January 2005 to December 2015, 85 cases of HCC diagnosed as spontaneous ruptured bleeding in the first affiliated Hospital of Guangxi Medical University were collected, of which 10 cases were treated conservatively (group A). 28 patients underwent surgical resection (group B), 19 patients received transarterial chemoembolism after surgical resection of tumor (group C), and 19 patients underwent transarterial chemoembolism after surgical resection of tumor (group C). 24 patients underwent arterial chemoembolization (group D) and 4 patients underwent phased hepatectomy () (E group after transarterial chemoembolization). In this study, the clinical data of simple surgical resection, simple TACE, conservative treatment, TACE after surgical resection and post-TACE resection before operation were analyzed retrospectively. the clinical data of simple resection, conservative treatment of TACE, surgical resection after surgical resection and surgical resection after operation were analyzed. Cox multivariate regression survival analysis was performed to determine the independent prognostic factors. Results: the overall survival rates of 85 patients with spontaneous rupture of HCC in 1 year, 2 years, 3 years, 4 years and 5 years were 30.6%, 18.8%, 14.1%, 5.9% and 3.5%, respectively. In group A (conservative treatment group), the median survival time of 10 patients was 1 month (1 鈮，

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