摘要
目的比较手术切除与经导管动脉化疗栓塞术(TACE)治疗肝细胞癌合并Ⅰ/Ⅱ型门静脉癌栓(portal vein tumor thrombus,PVTT)病人的疗效。方法选取中国医科大学附属盛京医院肝胆脾外科和介入科2012年6月至2017年12月收治的58例肝细胞癌合并Ⅰ/Ⅱ型门静脉癌栓(程氏分型)的病人为研究对象,分为外科切除治疗组(28例)和TACE治疗组(30例),比较两组长期生存率,并分析病人总体生存的独立危险因素。生存分析使用Kaplan-Meier法和Log-rank检验。多因素分析使用Cox比例风险回归模型。结果外科切除治疗组的中位生存期为13.0个月,0.5、1、2、3年生存率分别为74.7%、54.1%、29.2%、14.6%;TACE治疗组的中位生存期为6.4个月,0.5、1、2、3年生存率分别为53.3%、23.3%、13.3%、8.9%(P=0.036)。多因素分析显示多个肿瘤(HR=2.578;95%CI:1.365,4.868,P=0.004),天冬氨酸转氨酶(AST)>34U/L(HR=2.509;95%CI:1.266,4.972,P=0.008)是影响长期生存的独立影响因素。结论对于肝细胞癌伴Ⅰ/Ⅱ型门静脉癌栓病人,外科手术切除治疗明显好于TACE治疗,多个肿瘤和AST>34U/L是病人术后总体生存的独立影响因素。
Objective To compare the efficacy between hepatic resection and transcatheter arterial chemoembolization(TACE)for patients with hepatocellular carcinoma(HCC)with portal vein tumor thrombus(PVTT).Methods From June 2012 to December 2017,58 patients with HCC and typeⅠ/Ⅱ PVTT in Shengjing Hospital were enrolled in this study.According to different treatments,the patients were divided into hepatic resection group(28 cases)and TACE group(30 cases).The overall survival rate was compared and the independent risk factors.Kaplan-Meier method and Log-rank test were used for survial analysis,and Cox proportional hazard regression model was used for multivariate analysis.Results In the hepatic resection group,the median survival time was 13 months,and the 0.5-,1-,2-,3-year overall survival rate was 74.7%,54.1%,29.2% and 14.6%,respectively.In the TACE group,the median survival time was 6.4 months,and the 0.5-,1-,2-,3-year overall survival rate was 53.3%,23.3%,13.3%,8.9%,respectively.The multivariate analyses revealed that the significantly prognostic factors for overall survival were multiple tumor(HR=2.578,95%CI:1.365-4.868,P=0.008)and AST >34 U/L(HR=2.509,95%CI:1.266-4.972,P=0.008).Conclusions Hepatic resection is better than TACE for hepatocellular carcinoma with PVTT.Multiple tumor and AST >34 U/L were the independent influencing factors for postoperative overall survival.
作者
张学文
戴朝六
卜献民
苏洋
赵闯
彭松林
贾昌俊
徐锋
Zhang Xuewen;Dai Chaoliu;Bu Xianmin;Su Yang;Zhao Chuang;Peng Songlin;Jia Changjun;Xu Feng(Department of Hepatobiliary and Splenic Surgery, Shengjing Hospital of China Medical University ,Shenyang 110004,China)
出处
《腹部外科》
2018年第6期411-415,共5页
Journal of Abdominal Surgery
基金
2017年辽宁省重点研发计划指导计划项目(2017225032)
关键词
肝细胞癌
门静脉癌栓
手术切除
经导管动脉化疗栓塞术(TACE)
预后
Hepatocellular carcinoma
Portal vein tumor thrombus
Surgical treatment
Transcatheter arterial chemoembolization(TACE)
Prognosis
