中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2014年
20期
1526-1529
,共4页
郭哲%向邦德%张俊%姜经航%黎乐群
郭哲%嚮邦德%張俊%薑經航%黎樂群
곽철%향방덕%장준%강경항%려악군
癌,肝细胞%肝切除术%肝动脉化疗栓塞
癌,肝細胞%肝切除術%肝動脈化療栓塞
암,간세포%간절제술%간동맥화료전새
Carcinoma,hepatocellular%Hepatectomy%Transarterial chemoembolization
目的 比较肝切除与肝动脉化疗栓塞(TACE)治疗符合米兰标准肝细胞肝癌(HCC)患者的效果.方法 回顾性分析广西医科大学附属肿瘤医院2003年3月至2008年3月行肝切除或TACE治疗201例符合米兰标准且肝功能Child-PughA级HCC患者的临床资料,其中肝切除组159例,TACE组42例.采用倾向得分匹配法(PSM)均衡组间混杂因素的影响并获得匹配患者,Kaplan-Meier法计算累计生存率,Log-rank比较组间差异,Cox比例风险模型确定危险因素.结果 肝切除组与TACE组按2∶1匹配后分别获得84和42例患者,肝切除组及TACE组中位生存期分别为42.9个月和34.8个月,1、3、5年累计生存率分别为87.8％、64.0％、41.9％和85.7％、47.6％、26.0％(P =0.028).亚组分析结果提示:单个肿瘤且最大径≤5 cm患者肝切除组1、3、5年累计生存率分别为86.3％、61.3％、42.9％,与TACE组90.3％、61.3％、33.2％比较差异无统计学意义(P=0.332);而2～3个肿瘤且最大径≤3 cm患者肝切除组1、3、5年累计生存率分别为93.8％、75.0％、39.3％,明显高于TACE组72.7％ 、45.5％、9.1％ (P =0.002).Cox比例风险模型提示:体质指数≥23 kg/m2、AFP≥400 μg/L及TACE治疗是影响HCC患者预后的独立危险因素(均P＜0.05).结论 对于符合米兰标准肝癌患者,肝切除较TACE可明显提高患者远期生存.其中单个肿瘤且最大径≤5 cm患者肝切除与TACE疗效相当,而2～3个肿瘤且最大径≤3 cm患者肝切除疗效明显优于TACE.
目的 比較肝切除與肝動脈化療栓塞(TACE)治療符閤米蘭標準肝細胞肝癌(HCC)患者的效果.方法 迴顧性分析廣西醫科大學附屬腫瘤醫院2003年3月至2008年3月行肝切除或TACE治療201例符閤米蘭標準且肝功能Child-PughA級HCC患者的臨床資料,其中肝切除組159例,TACE組42例.採用傾嚮得分匹配法(PSM)均衡組間混雜因素的影響併穫得匹配患者,Kaplan-Meier法計算纍計生存率,Log-rank比較組間差異,Cox比例風險模型確定危險因素.結果 肝切除組與TACE組按2∶1匹配後分彆穫得84和42例患者,肝切除組及TACE組中位生存期分彆為42.9箇月和34.8箇月,1、3、5年纍計生存率分彆為87.8％、64.0％、41.9％和85.7％、47.6％、26.0％(P =0.028).亞組分析結果提示:單箇腫瘤且最大徑≤5 cm患者肝切除組1、3、5年纍計生存率分彆為86.3％、61.3％、42.9％,與TACE組90.3％、61.3％、33.2％比較差異無統計學意義(P=0.332);而2～3箇腫瘤且最大徑≤3 cm患者肝切除組1、3、5年纍計生存率分彆為93.8％、75.0％、39.3％,明顯高于TACE組72.7％ 、45.5％、9.1％ (P =0.002).Cox比例風險模型提示:體質指數≥23 kg/m2、AFP≥400 μg/L及TACE治療是影響HCC患者預後的獨立危險因素(均P＜0.05).結論 對于符閤米蘭標準肝癌患者,肝切除較TACE可明顯提高患者遠期生存.其中單箇腫瘤且最大徑≤5 cm患者肝切除與TACE療效相噹,而2～3箇腫瘤且最大徑≤3 cm患者肝切除療效明顯優于TACE.
목적 비교간절제여간동맥화료전새(TACE)치료부합미란표준간세포간암(HCC)환자적효과.방법 회고성분석엄서의과대학부속종류의원2003년3월지2008년3월행간절제혹TACE치료201례부합미란표준차간공능Child-PughA급HCC환자적림상자료,기중간절제조159례,TACE조42례.채용경향득분필배법(PSM)균형조간혼잡인소적영향병획득필배환자,Kaplan-Meier법계산루계생존솔,Log-rank비교조간차이,Cox비례풍험모형학정위험인소.결과 간절제조여TACE조안2∶1필배후분별획득84화42례환자,간절제조급TACE조중위생존기분별위42.9개월화34.8개월,1、3、5년루계생존솔분별위87.8％、64.0％、41.9％화85.7％、47.6％、26.0％(P =0.028).아조분석결과제시:단개종류차최대경≤5 cm환자간절제조1、3、5년루계생존솔분별위86.3％、61.3％、42.9％,여TACE조90.3％、61.3％、33.2％비교차이무통계학의의(P=0.332);이2～3개종류차최대경≤3 cm환자간절제조1、3、5년루계생존솔분별위93.8％、75.0％、39.3％,명현고우TACE조72.7％ 、45.5％、9.1％ (P =0.002).Cox비례풍험모형제시:체질지수≥23 kg/m2、AFP≥400 μg/L급TACE치료시영향HCC환자예후적독립위험인소(균P＜0.05).결론 대우부합미란표준간암환자,간절제교TACE가명현제고환자원기생존.기중단개종류차최대경≤5 cm환자간절제여TACE료효상당,이2～3개종류차최대경≤3 cm환자간절제료효명현우우TACE.
Objective To compare the long-term survival of hepatocellular carcinoma (HCC)patients within the Milan criteria who underwent hepatic resection (HR) or transarterial chemoembolization (TACE).Methods A total of 159 HR and 42 TACE patients with HCC within the Milan criteria were retrospectively evaluated.Propensity-score matching (PSM) was used to generate matched controls.Longterm survival was evaluated by the Kaplan-Meier method.And independent prognostic predictors were determined by the Cox proportional hazard model.Results After adjusting for baseline differences,84 HR and 42 TACE patients were selected.Median survival time was 42.9 months in HR group versus 34.8 months in TACE group.The 1,3 and 5-years survival rates were significantly higher in HR group (87.8％,64.0％,41.9％) than those in TACE group (85.7％,47.6％,26.0％ ; P =0.028).Subgroup analysis showed that the patients with single-tumor HCC ≤ 5 cm had 1,3 and 5-year overall survival rates of 86.3％,61.3％ and 42.9％ after HR versus 90.3％,61.3％ and 33.2％ after TACE (P =0.332).Among those with multinodular HCC involving 2-3 tumors ≤ 3 cm,1,3 and 5-years survival rates were 93.8％,75.0％ and 39.3％ after HR versus 72.7％,45.5％ and 9.1％ after TACE (P =0.002).Body mass index ≥ 23 kg/m2,serum level of alpha-fetoprotein (AFP) ≥ 400 μg/L and TACE treatment significantly predicted poor survival according to the Cox proportional hazard model (all P ＜ 0.05).Conclusions Hepatic resection provides better long-term survival than TACE for HCC patients within the Milan Criteria.In fact,HR provides significant long-term survival benefits for patients with multinodular HCC involving 2-3 tumors ≤ 3 cm.In contrast,both HR and TACE have similar survival rates among patients with single-tumor HCC ≤ 5 cm.
