中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2012年
6期
538-540
,共3页
唐腾骞%卢倩%刘祥德%杨星%廖睿%杨占宇
唐騰鶱%盧倩%劉祥德%楊星%廖睿%楊佔宇
당등건%로천%류상덕%양성%료예%양점우
肝肿瘤%肝移植%复发%转移%治疗
肝腫瘤%肝移植%複髮%轉移%治療
간종류%간이식%복발%전이%치료
Liver neoplasms%Liver transplantation%Recurrence%Metastasis%Treatment
目的 总结肝癌患者行肝移植术后复发、转移的治疗方法,探讨其疗效,分析影响复发、转移后生存时间的危险因素.方法 本研究回顾性分析1999年1至2011年9月第三军医大学西南医院收治的行肝癌肝移植患者的临床资料.99例患者肝移植术后发生肝癌复发、转移,其中7例因不符合本研究标准予以剔除,最终纳入92例患者的临床资料,根据治疗方案将患者分为单一治疗组(18例)和综合治疗组(74例).比较两组患者的生存时间,并分析影响肝癌复发、转移患者预后的危险因素.计量资料比较采用t检验,计数资料采用x2检验或Fisher确切概率法.采用Kaplan-Meier法绘制生存曲线,生存分析采用Log-rank检验,患者预后因素采用多元线性回归分析.结果 单一治疗组和综合治疗组患者肝癌复发、转移后生存时间分别为(5.5±1.1)个月和(8.5±1.6)个月,两组比较,差异有统计学意义(Log-rank值为7.489,P＜0.05).92例患者中,TNM分期Ⅱ期和ⅢA期患者肝癌复发、转移后生存时间为(7.9±1.5)个月,ⅢB期和ⅣA期患者为(7.0±1.3)个月,两者比较,差异有统计学意义(Log-rank值为2.567,P＜0.05).分化程度:高、中分化患者肝癌复发、转移后生存时间为(8.1±1.5)个月,低分化患者为(7.2±1.4)个月,两者比较,差异有统计学意义(Log-rank值为2.749,P＜0.05).多元线性回归分析结果表明:肿瘤TNM分期、肿瘤分化程度、是否符合米兰标准、是否合并大血管侵犯是影响患者肝癌复发、转移后生存时间的独立危险因素(t =2.610,3.132,4.378,2.258,P＜0.05).结论 综合治疗可明显延长肝癌复发、转移后患者的生存时间.肝移植术后患者肝癌复发、转移发生时间越早,恶性程度越高,生存时间越短.肿瘤TNM分期、肿瘤分化程度、是否符合米兰标准、是否合并大血管侵犯是影响患者生存时间的危险因素.
目的 總結肝癌患者行肝移植術後複髮、轉移的治療方法,探討其療效,分析影響複髮、轉移後生存時間的危險因素.方法 本研究迴顧性分析1999年1至2011年9月第三軍醫大學西南醫院收治的行肝癌肝移植患者的臨床資料.99例患者肝移植術後髮生肝癌複髮、轉移,其中7例因不符閤本研究標準予以剔除,最終納入92例患者的臨床資料,根據治療方案將患者分為單一治療組(18例)和綜閤治療組(74例).比較兩組患者的生存時間,併分析影響肝癌複髮、轉移患者預後的危險因素.計量資料比較採用t檢驗,計數資料採用x2檢驗或Fisher確切概率法.採用Kaplan-Meier法繪製生存麯線,生存分析採用Log-rank檢驗,患者預後因素採用多元線性迴歸分析.結果 單一治療組和綜閤治療組患者肝癌複髮、轉移後生存時間分彆為(5.5±1.1)箇月和(8.5±1.6)箇月,兩組比較,差異有統計學意義(Log-rank值為7.489,P＜0.05).92例患者中,TNM分期Ⅱ期和ⅢA期患者肝癌複髮、轉移後生存時間為(7.9±1.5)箇月,ⅢB期和ⅣA期患者為(7.0±1.3)箇月,兩者比較,差異有統計學意義(Log-rank值為2.567,P＜0.05).分化程度:高、中分化患者肝癌複髮、轉移後生存時間為(8.1±1.5)箇月,低分化患者為(7.2±1.4)箇月,兩者比較,差異有統計學意義(Log-rank值為2.749,P＜0.05).多元線性迴歸分析結果錶明:腫瘤TNM分期、腫瘤分化程度、是否符閤米蘭標準、是否閤併大血管侵犯是影響患者肝癌複髮、轉移後生存時間的獨立危險因素(t =2.610,3.132,4.378,2.258,P＜0.05).結論 綜閤治療可明顯延長肝癌複髮、轉移後患者的生存時間.肝移植術後患者肝癌複髮、轉移髮生時間越早,噁性程度越高,生存時間越短.腫瘤TNM分期、腫瘤分化程度、是否符閤米蘭標準、是否閤併大血管侵犯是影響患者生存時間的危險因素.
목적 총결간암환자행간이식술후복발、전이적치료방법,탐토기료효,분석영향복발、전이후생존시간적위험인소.방법 본연구회고성분석1999년1지2011년9월제삼군의대학서남의원수치적행간암간이식환자적림상자료.99례환자간이식술후발생간암복발、전이,기중7례인불부합본연구표준여이척제,최종납입92례환자적림상자료,근거치료방안장환자분위단일치료조(18례)화종합치료조(74례).비교량조환자적생존시간,병분석영향간암복발、전이환자예후적위험인소.계량자료비교채용t검험,계수자료채용x2검험혹Fisher학절개솔법.채용Kaplan-Meier법회제생존곡선,생존분석채용Log-rank검험,환자예후인소채용다원선성회귀분석.결과 단일치료조화종합치료조환자간암복발、전이후생존시간분별위(5.5±1.1)개월화(8.5±1.6)개월,량조비교,차이유통계학의의(Log-rank치위7.489,P＜0.05).92례환자중,TNM분기Ⅱ기화ⅢA기환자간암복발、전이후생존시간위(7.9±1.5)개월,ⅢB기화ⅣA기환자위(7.0±1.3)개월,량자비교,차이유통계학의의(Log-rank치위2.567,P＜0.05).분화정도:고、중분화환자간암복발、전이후생존시간위(8.1±1.5)개월,저분화환자위(7.2±1.4)개월,량자비교,차이유통계학의의(Log-rank치위2.749,P＜0.05).다원선성회귀분석결과표명:종류TNM분기、종류분화정도、시부부합미란표준、시부합병대혈관침범시영향환자간암복발、전이후생존시간적독립위험인소(t =2.610,3.132,4.378,2.258,P＜0.05).결론 종합치료가명현연장간암복발、전이후환자적생존시간.간이식술후환자간암복발、전이발생시간월조,악성정도월고,생존시간월단.종류TNM분기、종류분화정도、시부부합미란표준、시부합병대혈관침범시영향환자생존시간적위험인소.
Objective To summarize the strategies of treatment and investigate the risk factors affecting the survival of patients with hepatic cancer recurrence and metastasis after liver transplantation.Methods The clinical data of 99 patients with hepatic cancer recurrence and metastasis after liver transplantation who were admitted to the Southwest Hospital of Third Military Medical University from January 1999 to September 2011 were retrospectively analyzed.Of the 99 patients,7 patients who did not meet the criteria were excluded from the study,and 92 patients were enrolled in the study.All patients were divided into single therapy group (18 patients) and combined therapy group (74 patients).The study was reviewed by the ethics committee,and all the patients signed the informed consent form.The survival time of the 2 groups was compared,and the risk factors affecting the survival time was analyzed.All data were analyzed using the t test,chi-square test or by calculating the Fisher exact probability.The survival curve was drawn using the Kaplan-Meier method,and the survival time was compared by the Log-rank test.Factors influencing the prognosis were analyzed using the multivariate linear regression analysis.Results The survival time of patients in the single therapy group and the combined therapy group after hepatic cancer recurrence and metastasis were (5.5 ± 1.1) months and (8.5 ± 1.6) months,respectively,with a significant difference between the 2 groups (Log-rank value =7.489,P ＜ 0.05).The survival time were (7.9 ± 1.5) months for patients in TNM Ⅱ and Ⅲ A,and (7.0 ± 1.3) months for patients in TNM Ⅲ B and ⅣA,with significant difference between the 2 groups (Log-rank value =2.567,P ＜0.05).The survival time of patients with moderately or well differentiated tumors after tumor recurrence and metastasis was (8.1 ± 1.5) months,which was significantly longer than (7.2 ± 1.4)months of patients with poorly differentiated tumor (Log-rank value =2.749,P ＜ 0.05).TNM stage,tumor differentiation,Milan criteria,great vessel invasion were independent factors affecting the survival of patients with hepatic cancer recurrence and metastasis (t =2.610,3.132,4.378,2.258,P ＜ 0.05).Conclusions Combined therapy can significantly prolong the survival time of patients with hepatic cancer recurrence and metastasis.Earlier hepatic cancer recurrence and metastasis after liver transplantation result in a shorter survival time.TNM stage,tumor differentiation,great vessel invasion and Milan criteria are risk factors affecting the survival of patients with hepatic cancer recurrence and metastasis after liver transplantation.
