原发性肝癌TACE综合治疗预后多因素分析

目的：评价与分析多因素对原发性肝细胞肝癌TACE为主的综合治疗预后的影响，筛选与预后相关的因素。方法:选择我院1996年1月～1999年6月间收治的141例原发性肝细胞肝癌病例，其中男125例，女16例,21～76岁，中位年龄为52岁；TACE综合治疗方法包括TACE治疗、TACE+手术切除、TACE+PEI治疗、TAI治疗。根据回归多因素模型的拟合结果分析影响预后的13项因素，即病人年龄、性别、血清AFP、ALT、HbsAg、肝功能Child分级、治疗方式、肿瘤大小及数目、血清白蛋白水平、门静脉癌栓形成与否、肿瘤大体病理类型以及血清HbeAg， 并对其进行评价。Wald χ2统计。结果:本组患者总体中位生存时间19个月，平均生存时间为23.59个月。1、2、3、5年累计生存率分别为63.91%、44.47%、25.76%、7.38%（95%可信区间）。多因素分析显示：患者的年龄、肝功能Child分级、治疗方式、门静脉癌栓形成与否以及肝癌的大体病理类型5个因素与肝癌TACE综合治疗预后有关（χ2=45.993，P=0.000?1）。结论:患者的年龄、肝功能Child分级、门静脉癌栓形成与否以及肝癌的大体病理类型是肝细胞肝癌TACE综合治疗预后的危险因素，治疗方式是影响预后的保护性因素。

Analysis of factors affecting the prognosis of combinated transcatheter hepatic artery chemoembolization in patients with primary hepatic carcinoma

To analyse factors affecting the prognosis in patients with primary hepatic carcinoma treated with combinated transcatheter hepatic artery chemoembolization (TACE). Methods: A total of 141 consecutive patients including 125 men and 16 women (mean 52 years old, ranged from 21 to 76 years) with primary hepatic carcinoma were treated from January 1996 to June 1999. Of them, 17 received TACE and surgical resection, 17 received TACE and percutaneous ethanol injection (PEI), 100 only TACE, 7 transcatheter hepatic artery infusion (TAI). Cox′s regression analysis model was used to analyse the factors including sex, age, ALT, AFP, HbsAg, liver function (Child′s system), the way of treatment, tumor size and number , serum albumin, portal cancerous thrombus, tumor pattern and HbeAg（sle=0.2, sls=0.05）. Results: Total mid survival time was 19 months(mean 23.59 months). Total survival rates of 1, 2, 3 and 5 years were 63.91%, 44.47%, 25.76% and 7.38% respectively(95% confidence limit). Multivariable analysis revealed significant prognostic factors as follows: age, liver function, the way of treatment, portal cancerous thrombus and tumor pattern（χ2=45.993, P=0.000?1）. Conclusion: In this study, age, liver function, portal cancerous thrombus and tumor pattern are the risk prognostic factors, and treatment way is a protective factor（χ2=45.993， P=0.000?1）.