CAJ | 학술논문

目的：观察门静脉免疫化疗对原发性肝癌切除后患者预后的影响。方法收集湖北医药学院附属太和医院2010年1月－2013年6月住院的48例手术切除并行术后门静脉免疫化疗患者，对其临床资料进行回顾性分析，并与同期未行门静脉免疫化疗的59例患者进行对比。计量资料的分析采用两样本资料的t检验，率的检验采用卡方检验。生存分析采用Kaplan－Meirer法计算平均生存时间，采用log－rank 检验分析不同组之间的差异性。将107例患者合并，采用Cox回归模型分析对可能影响预后的因素进行多因素分析。结果免疫化疗组和对照组的1、2、3年的无瘤生存率分别为87．5％（42/48）和67．8％（40/59）（χ2＝5．739，P＝0．017）、52．1％（25/48）和32．2％（19/59）（χ2＝4．320，P＝0.038）、16．7％（8/48）和10．2％（6/59）（χ2＝0．982，P＝0．322），平均生存时间分别为（32．4±2．3）个月和（24．7±2．3）个月（χ2＝4.044，P＝0．044）。合并门静脉癌栓者术后行门静脉免疫化疗其平均生存时间（12．4±1．3）个月，而未行门静脉免疫化疗者为（4．8±0．4）个月（χ2＝15．535，P＜0．001）。经Cox回归分析显示，肿瘤的分化程度、肿瘤的大小、肝功能分级、是否存在门静脉癌栓是影响肝细胞切除术后复发的独立危险因素，而是否采用门静脉免疫化疗对影响肝癌术后的复发时间有重要影响，具有统计学意义（P＜0．001）。结论门静脉免疫化疗可改善原发性肝癌切除后的无瘤生存率和生存时间。
목적：관찰문정맥면역화료대원발성간암절제후환자예후적영향。방법수집호북의약학원부속태화의원2010년1월－2013년6월주원적48례수술절제병행술후문정맥면역화료환자，대기림상자료진행회고성분석，병여동기미행문정맥면역화료적59례환자진행대비。계량자료적분석채용량양본자료적t검험，솔적검험채용잡방검험。생존분석채용Kaplan－Meirer법계산평균생존시간，채용log－rank 검험분석불동조지간적차이성。장107례환자합병，채용Cox회귀모형분석대가능영향예후적인소진행다인소분석。결과면역화료조화대조조적1、2、3년적무류생존솔분별위87．5％（42/48）화67．8％（40/59）（χ2＝5．739，P＝0．017）、52．1％（25/48）화32．2％（19/59）（χ2＝4．320，P＝0.038）、16．7％（8/48）화10．2％（6/59）（χ2＝0．982，P＝0．322），평균생존시간분별위（32．4±2．3）개월화（24．7±2．3）개월（χ2＝4.044，P＝0．044）。합병문정맥암전자술후행문정맥면역화료기평균생존시간（12．4±1．3）개월，이미행문정맥면역화료자위（4．8±0．4）개월（χ2＝15．535，P＜0．001）。경Cox회귀분석현시，종류적분화정도、종류적대소、간공능분급、시부존재문정맥암전시영향간세포절제술후복발적독립위험인소，이시부채용문정맥면역화료대영향간암술후적복발시간유중요영향，구유통계학의의（P＜0．001）。결론문정맥면역화료가개선원발성간암절제후적무류생존솔화생존시간。
Objective To observe the prognostic impact of portal vein immunochemotherapy in patients after resection of primary hepatocel-lular carcinoma (HCC).Methods A retrospective analysis was performed on the clinical data of 48 patients who received portal vein im-munochemotherapy after resection of primary HCC (immunochemotherapy group)and 59 patients who did not receive portal vein immunoche-motherapy after resection of primary HCC (control group).Continuous data were analyzed by two-sample t-test;rates were compared withχ2 test.Survival analysis was performed by the Kaplan-Meirer method for calculating the mean survival time;the survival differences be-tween the two groups were analyzed with the log-rank test.The prognostic factors in all the 107 patients were analyzed using a multivariate Cox regression model.Results The 1 -,2-,and 3-year disease-free survival (DFS)rates of the immunochemotherapy group and con-trol group were 87.5%(42/48)vs 67.8%(40/59)(χ2 =5.739,P=0.017),52.1%(25/48)vs 32.2%(19/59)(χ2 =4.320,P=0.038),and 16.7% (8/48)vs 10.2%(6/59)(χ2 =0.982,P=0.322),respectively,and the mean survival time of the two groups was 32.4 ±2.3 months vs 24.7 ±2.3 months (χ2 =4.044,P=0.044).Among the cases complicated by portal vein tumor thrombosis,those receiving postoperative portal vein immunochemotherapy had a mean survival time of 12.4 ±1.3 months,versus 4.8 ±0.4 months for those not receiving postoperative portal vein immunochemotherapy (χ2 =15.535,P<0.001).Cox regression analysis revealed that pathological differen-tiation,tumor size,liver function grade,and portal vein tumor thrombus were independent prognostic factors for the recurrence in patients af-ter resection of primary HCC.Whether to receive portal vein immunochemotherapy is related to postoperative recurrence time (P<0.001). Conclusion Portal vein immunochemotherapy could improve the DFS rate and survival time in patients after resection of primary HCC.