经肝动脉化疗栓塞术治疗肝细胞癌的预后影响因素分析

摘要

目的：探讨中晚期肝细胞癌（HCC）患者行肝动脉化疗栓塞术（TACE）的预后影响因素。方法回顾性分析南京医科大学附属淮安第一医院2007年5月－2012年5月收治的124例行TACE治疗的中晚期HCC患者的临床资料。应用Kaplan－Meier法计算累积生存率，Log－rank法进行检验；各影响因素行单因素Cox分析，再用多因素Cox逐步回归分析。结果124例患者均获得随访，随访时间为3～40个月，患者0．5、1、2、3年累积生存率分别为97．6％、74．2％、15．5％、4．1％，中位生存时间为482 d。单因素分析显示，术前血清甲胎蛋白（AFP）水平、肿瘤大小、有无门静脉癌栓、肿瘤临床分期是HCC患者TACE预后的影响因素（P值均＜0.001）；进一步多因素Cox逐步回归分析显示，肿瘤大小、肿瘤临床分期、术前血清AFP水平、门静脉癌栓是HCC患者TACE预后的独立危险因素（Wald值分别为7．428、7．699、15．235、5．803，P值均＜0．05）。结论肿瘤大小、肿瘤临床分期、术前血清AFP水平、有无门静脉癌栓是HCC患者TACE预后的独立危险因素，对临床判断预后及治疗方案的选择有指导意义。%Objective Toinvestigatetheprognosticfactorsfortranscatheterarterialchemoembolization(TACE)inpatientswithadvanced primaryhepatocellularcarcinoma(HCC).Methods Theclinicaldataof124patientswithadvancedHCCwhowereadmittedtoHuaian No.1 People′s Hospital Affiliated to Nanjing Medical University and underwent TACE from May 2007 to May 2012 were analyzed retrospec-tively.The Kaplan-Meier method was used to calculated cumulative survival rates,and the log-rank test was used for survival difference analysis and univariate prognostic analysis;the Cox univariate analysis was applied to determine risk factors,and the Cox multivariate step-wiseregressionanalysiswasappliedtodetermineindependentriskfactors.Results Follow-upvisitswereperformedforallpatients,and the time for follow-up visits was 3 -40 months.The 0.5 -,1 -,2 -,and 3 -year cumulative survival rates of these patients were 97.6%,74.2%,15.5%,and 4.1%,respectively,with a median survival time of 482 days.Univariate analysis showed that preoperative serum alpha-fetoprotein (AFP)level,tumor size,presence or absence of portal vein tumor thrombus,and tumor stage were the prognostic factors in patients with HCC undergoing TACE (all P<0.001);Cox multivariate stepwise regression analysis showed that tumor size,tumor stage,preoperative serum AFP level,and presence or absence of portal vein tumor thrombus were the independent prognostic factors (Wald values=7.428,7.699,15.235,and5.803,respectively,allP<0.05).Conclusion Tumorsize,tumorstage,preoperativeserumAFP level,and presence or absence of portal vein tumor thrombus are the independent prognostic factors in patients with HCC undergoing TACE, and can guide the prognosis and selection of therapeutic regimens in clinical practice.