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中国癌症防治杂志

中国癌症防治杂志 ›› 2014, Vol. 6 ›› Issue (4): 363-370.doi: 10.3969/j.issn.1674-5671.2014.04.09

• 临床研究 • 上一篇    下一篇

巴塞罗那中晚期肝细胞癌肝切除术和经肝动脉化疗栓塞术的疗效分析

  

  1. 广西医科大学附属肿瘤医院 肝胆外科，超声诊断科
  • 出版日期:2014-12-25 发布日期:2015-01-12
  • 通讯作者: 马良 E-mail:malianggxyd@163.com
  • 基金资助:

    国家自然科学基金资助项目（81160262）；广西卫生厅科研基金资助项目（Z2014241，GZPT1240）；广西医科大学青年科学基金资助课题（GXMUYSF201302）

Comparative efficacy of hepatic resection or transarterial chemoembolization for treating intermediate-and advanced-stage hepatocellular carcinoma

  • Online:2014-12-25 Published:2015-01-12

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被引次数

12

摘要： 目的 评价肝切除术和经肝动脉化疗栓塞术（transarterial chemoembolizaiton，TACE）治疗巴塞罗那中晚期肝细胞癌（hepatocellular carcinoma，HCC）患者的疗效和安全性。方法 回顾性分析2000～2007年接受肝切除术（n=908）和TACE（n=351）治疗的1 259例中晚期HCC患者，比较两组患者的并发症发生率、死亡率及总生存率，并使用倾向性分析匹配组间基线资料。结果 肝切除术组患者术后并发症发生率显著高于TACE治疗组（26.8% vs 18.5%，P=0.005），两组患者术后90 d的死亡率相似（3.1% vs 2.8%，P=0.827）。肝切除术组和TACE组患者的1年、3年、5年总生存率分别为88%、62%、39%和81%、33%、16%，差异有统计学意义（P<0.001）。倾向性分析和基于肿瘤大小、肿瘤数量、大血管侵犯、门静脉高压与否的亚组分析同样显示接受肝切除术治疗的患者总生存率显著优于TACE治疗的患者。多因素分析结果显示，甲胎蛋白≥400 ng/ml、糖尿病、大血管侵犯、门静脉高压和TACE治疗是中晚期HCC患者预后不良的独立危险因素。结论 对于肝功能Child-Pugh A级的HCC患者，孤立性大肿瘤、多结节、大血管侵犯或合并门静脉高压均非肝切除术治疗的禁忌证，且肝切除术的疗效明显优于TACE治疗。

关键词: 肝肿瘤, 肝切除术, 经肝动脉化疗栓塞, 总生存率, 巴塞罗那临床肝癌分期系统, 倾向性分析

Abstract: Objeclive Different official guidelines recommend different treatment modalities for intermediate-and advanced-stage hepatocellular carcinoma （HCC）. The aim of this study was to explore the safety and efficacy of hepatic resection（HR） in these patients. Methods Between 2000 and 2007，a consecutive sample of 1 259 patients with intermediate and advanced stage HCC who underwent HR （n=908） or transarterial chemoembolization （TACE，n=351） were included. Propensity score-matched patients were analyzed to adjust for any baseline differences. Results The 90-day mortality rates in the HR and TACE groups were 3.1% and 2.8% （P=0.827）. The morbidity rate was significantly higher in the HR group （26.8%） than in the TACE group （18.5%，P=0.005）. HR provided a survival benefit over TACE at 1，3，and 5 years （88% vs 81%，62% vs 33%， and 39% vs 16%，respectively；P<0.001）. Propensity scoring and subgroup analyses based on tumor size，tumor number， presence or absence of macrovascular invasion，and portal hypertension （PHT） also showed that HR was associated with better long-term survival than TACE. Multivariate analyses revealed that alpha-fetoprotein ≥400 ng/ml， diabetes mellitus， macrovascular invasion，and PHT were independent predictors of poor prognosis. Conclusions For patients with HCC and Child-Pugh A liver function， the presence of a solitary large tumor，multin-odular tumors， macrovascular invasion，or PHT are not contraindications for HR. For these patients，HR provides better survival than TACE.

Key words: Liver neoplasm, Hepatic resection, Transarterial chemoembolization, Overall survival, Barcelona Clinic Liver Cancer, propensity score analysis