166例中晚期肝癌介入治疗预后多因素Cox模型分析

目的综合分析影响肝癌患者介入治疗预后的主要因素,为原发性肝癌患者制定合理的治疗方案及估计介入治疗预后提供理论依据. 方法对166例行经动脉化疗栓塞术治疗的肝癌患者进行回顾性分析.对影响因素行Cox回归分析,应用Kaplan-Meier法计算累积生存率,Log-rank检验方法检验. 结果总体6个月及1、2、3 年累积生存率分别为:78.54%、47.23%、23.68%、14.09%;中位生存期12个月.单因素Cox模型分析对预后影响有意义的变量有:性别、肝功能Child分级、临床Okuda分期、术前AFP升高且介入后AFP变化、治疗次数、肿块类型、肿瘤最大径、肿瘤容积、肿瘤与肝脏容积百分比(瘤肝比)、门静脉癌栓、有无转移、碘化油沉积程度、肿瘤缩小率、肿瘤边缘、经皮无水乙醇消融术及其他疗法等.但多因素分析后仅瘤肝比、门静脉癌栓、治疗次数及术前AFP升高且介入后AFP变化为影响预后有显著意义的因素. 结论较小瘤肝比及重复介入治疗是提高肝癌预后有意义因素;伴门静脉癌栓的肝癌应积极治疗;综合治疗可进一步提高疗效.

The Cox proportional hazard regression model study of prognostic factors in patients with advanced primary liver carcinoma treated with transcatheter arterial chemombolization

Objective To analyse major prognostic factors of transcatheter arterial chemoembolization(TACE) to the patients with advanced primary liver carcinoma(PLC) and to provide a theoretical basis for interventional treatment of PLC. Methods 166 PLC patients treated with TACE were studied retrospectively. Univariable analysis and multivariate Cox proportional hazard regression model were used to analyze the factors affecting the prognosis. Results The overall cumulative survival rates for 6,12,24 and 36 months were 78.54%, 47.23%, 23.68% and 14.09% respectively. The median survival time was 12 months. Univariate analysis identified 16 parameters of prognostic significance. The main factors affecting the prognosis includ sex, tumor type, Child-Pugh's grade of liver function, Okuda's stage, decrease in AFP concentration after treatment, portal cancerous thrombus, times of treatment, extrahepatic spread, tumor size, tumor volume, tumor-to-liver volume ratio, tumor margin, tumor regression rate, degree of lipiodol retention within the tumor, percutaneous ethanol injection(PEI) and integrative treatment. Multivariate analysis showed that tumor-to-liver volume ratio, portal cancerous thrombus, times of treatment and decrease in AFP concentration after treatment were significant factors. Conclusion Retreatment and less tumor-to-liver volume ratio are beneficial prognostic factors predicting longer survival time of PLC. PLC with Portal cancerous thrombus should be treated more regorously. Integrative treatment can prolong the survival time of advanced PLC.