全程关护诊疗模式对肝癌患者预后的影响

目的 探讨全程关护诊疗（total care and treatment，TCT）模式对肝癌患者预后的影响。方法 回顾性分析2012年1月至2015年12月广西医科大学附属肿瘤医院、贵港市人民医院1 810例肝癌患者资料，按照是否行TCT模式诊疗将患者分成TCT模式组和常规诊疗模式组，比较两组行根治性治疗术患者1年、2年复发率、复发后治疗率及生存率。结果 共收集行TCT模式诊疗肝癌患者1 054例（TCT模式组）和常规诊疗模式患者756例（常规诊疗模式组），其中TCT模式组行根治性治疗术784例，常规诊疗模式组556例。 TCT模式组行根治性治疗患者1年和2年复发率与常规诊疗模式组比较，差异均无统计学意义（20.54% vs 21.22%，χ²=0.093，P=0.760；40.31% vs 41.19%，χ²=0.105，P=0.746）；TCT模式组1年和2年复发后治疗率高于常规诊疗模式组（100% vs 57.63%，χ²=9.836，P=0.020；100% vs 56.77%，χ²=7.679，P=0.060）。1年、2年总生存率亦高于常规诊疗模式组（83.20% vs 79.28%，P＜0.05；67.12% vs 59.31%，P＜0.05） 结论 肝癌全程关护诊疗模式符合肝癌治疗系统、序贯、个体化需求的规律，在行根治性治疗术患者中，两种诊疗模式患者复发率相当，但TCT模式诊疗患者复发后治疗率提高。

Implementation of the total care and treatment model in the diagnosis and treatment of hepatocellular carcinoma

Objective To investigate the effects of the total care and treatment（TCT） model in the diagnosis and treatment of hepato-cellular carcinoma in Guangxi. Methods Medical records were retrospectively analyzed for 1，810 patients who were diagnosed and initially treated at Affiliated Tumor Hospital of Guangxi Medical University  and Guigang People's Hospital between January 2012 and December 2015. Patients were allocated to the TCT group or conventional diagnosis and treatment group  based on the diagnosis and treatment model that they received. Baseline characteristics and prognosis were compared between the two groups. Results A total of 1，054 patients in TCT group and 756 patients in conventional diagnosis and treatment group. While 784 patients in TCT group and 556 patients in con-ventional diagnosis and treatment group underwent hepatectomy or radiofrequency ablation.Among patients who underwent hepatectomy or radiofrequency ablation，1 and 2 years recurrence rates were similar in two groups.Treatment rates after recurrence at 1 or 2 years were higher in the TCT group than in the conventional group（100% vs 57.63%，χ²=9.836，P=0.020；100% vs 56.77%，χ²=7.679，P=0.060）. For the entire cohort，1 or 2 years cumulative survival was higher in the TCT group than in the conventional group （83.20% vs 79.28%，P<0.05；67.12% vs 59.31%，P＜0.05）. Conclusion The TCT model，a sequential individualized treatment model for hepatocellular carcinoma，may be associated with better prognosis than conventional diagnosis and treatment for hepatocellular carcinoma patients in Guangxi.