摘要
目的:探讨不同介入方案对原发性肝癌的治疗效果及影响其预后的相关因素分析.方法:收集2002-06/2006-10我院收治的原发性肝癌患者193例,按治疗方法分4组:单纯行肝动脉化学栓塞(TACE)组56例,单纯行射频消融(RFA)组52例,TACE+RFA组45例,RFA+TACE组40例.对各组患者进行随访,并比较治疗后肿瘤体积和甲胎蛋白含量变化及生存率、生存期.以患者生存期作为因变量,搜集可能影响肝癌患者介入治疗预后的因素,用Cox回归模型分析影响预后的因素.结果:四组治疗后肿瘤体积变化评估比较有统计学差异(P<0.01),以TACE+RFA组疗效最好,RFA+TACE组次之;TACE+RFA组的AFP改善情况较其他三组明显,差异有统计学意义(P<0.05);四组中位生存期和0.5,1,1.5,2,3a生存率比较存在统计学差异(P<0.05),TACE+RFA组生存率最高,中位生存期最长,RFA+TACE组次之;单因素分析结果显示:肝功能Child-Pugh分级、门脉癌栓、治疗方式、治疗后肿瘤体积变化和治疗后AFP值2变化与预后显著相关;多因素分析结果显示,门脉癌栓、是否行TACE+RFA治疗与预后显著相关,是影响肝癌介入预后的独立影响因素.结论:RFA和TACE联合应用是治疗原发性肝癌的一种有效治疗方法,比单纯TACE或RFA更具有明显的优越性,且宜先行TACE再行RFA;有无癌栓、是否行TACE+RFA治疗是影响介入治疗预后的独立危险因素.
AIM：To evaluate the efficiency of different interventional mode in treating primary hepatocellular carcinoma and the factor affecting the prognosis.METHODS：193 cases with hepatocellular carcinoma from 2002 to 2006 were undertaken transcatheter arterial chemoembolization（TACE group,n=56）,radiofrequency ablation（RFA group,n=52）,TACE and RFA（TACE＋RFA group,n=45）,RFA and TACE（RFA＋TACE group,n=40）.The Cox＇s regression analysis model was used to analyse the factors affecting the prognosis.RESULTS：In the 4 groups,TACE＋RFA group obtained the best curative effect,the highest survival rate and the longest middle life span;The best achievement on the loss degree of AFP value also happened in TACE＋RFA group.Cox regression simplex actor analysis display significantly influential factors such as liver functional classification,carcinoma lock,tumour diminution rate,treatment and AFP value of post-treatment.Multiplicity display that carcinoma lock and TACE＋RFA treatment two factors make sense to prognosis.CONCLUSION：Of the 3 groups,TACE＋RFA method have better curative effect than with either TACE or RFA.The impact of intervention in the treatment of liver cancer prognosis is an important factor：the availability of tumor thrombus and TACE＋RFA treatment.
出处
《第四军医大学学报》
北大核心
2009年第24期3068-3071,共4页
Journal of the Fourth Military Medical University
关键词
原发性肝癌
介入治疗
预后
primary hepatic carcinoma
interventional procedure
prognosis
