肝动脉化疗栓塞治疗乙型肝炎相关性肝癌的预后影响因素

目的通过分析肝动脉化疗栓塞(TACE)治疗乙型肝炎相关性肝癌的预后影响因素,为临床合理选择适应证及治疗方案提供依据。方法选择自2010年1月到2010年12月在本院行TACE治疗的乙型肝炎相关性肝癌患者140例为研究对象,随访截止日期为2011年12月,观察12个月生存情况。采用Kaplan Meier时序检验及对数秩Log Rank(Mantel-Cox)检验进行单因素及多因素分析,筛选TACE治疗的乙型肝炎相关性肝癌患者的预后影响因素。结果单因素分析结果显示年龄、门静脉转移、腹腔转移、胸腔转移、Child-Pugh分级、胆红素、AST、介入治疗次数、抗病毒治疗对患者预后有影响,TACE联合抗病毒治疗组12个月生存曲线与未抗病毒治疗组有明显差异(P0.05)。多因素分析结果显示门静脉转移(P=0.004)、腹腔转移(P=0.009)、胆红素水平(P=0.017)、抗病毒治疗(P=0.000)、TACE治疗次数(P=0.000)与TACE治疗的乙型肝炎相关性肝癌患者的预后相关。结论门静脉转移、腹腔转移、胆红素水平可能为影响TACE治疗的乙型肝炎相关性肝癌患者预后的独立危险因素,抗病毒治疗、介入治疗次数可能为保护性因素。

Prognostic factors in patients with hepatitis B - related primary liver cancer treated with transcatheter arterial chemo- embolization

Objective To analyze the prognostic factors in patients with hepatitis B - related primary liver cancer treated with transcatheter arterial chemoembolization （TACE） and to provide a basis for properly selecting indications and treatment regimen in clinical practice. Methods A total of 140 patients with hepatitis B - related primary liver cancer, who underwent TACE in our hospital from January to December 2010, were enrolled in this study. Follow - up was continued until December 2011 to observe the patients＇ survival within 12 months after treatment. The Kaplan - Meier method and log - rank （ Mantel - Cox） test were used for univariate and multivariate analyses to identify the prognostic factors in patients with hepatitis B - related primary liver cancer treated with TACE. Results The univariate analysis showed that age, portal vein metastasis, peritoneal metastasis, pleural metastasis, Child - Pugh classification, bilirubin, alanine aminotransferase, number of interventional therapies, and antiviral therapy were prognostic factors in patients with hepatitis B - related primary liver cancer treated with TACE. There was significant difference in 12 - month survival curve between patients treated with TACE plus antiviral therapy and those who did not receive antiviral therapy （ P 〈 0.05 ）. The multivariate analysis showed that portal vein metastasis （ P -- 0. 004 ）, peri- toneal metastasis （ P = 0.009 ）, bilirubin level （ P = 0.017 ） , antiviral therapy （ P = 0. 000 ）, and number of TACE therapies （ P = 0. 000 ） were prognostic factors in patients with hepatitis B - related primary liver cancer treated with TACE. Conclusion Portal vein metastasis, peritoneal metastasis, and bilirubin level may be independent risk factors in patients with hepatitis B - related primary liver cancer treated with TACE, and antiviral therapy and number of interventional therapies may be protective factors for these patients.