肝动脉化疗栓塞治疗乙肝相关性肝细胞癌患者预后的影响因素
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摘要
目的探讨影响经导管肝动脉化疗栓塞(TACE)治疗乙肝相关性肝细胞癌患者预后的相关因素。方法随机选取2013年1月至2015年12月收治的行TACE治疗的乙型肝炎相关性肝细胞癌患者120例作为研究对象,观察入选患者1年的生存情况,随访观察2016年12月截止。对影响TACE治疗的乙型肝炎相关性肝细胞癌患者预后的相关因素进行分析。结果单因素分析结果显示,抗病毒治疗、低门冬氨酸氨基转移酶(AST)水平(<80 U/L)、低血清胆红素水平(<34.2μmol/L)、Child-Pugh分级较低、无腹腔转移、无胸腔转移、无门静脉转移、年龄较低、介入治疗次数较多(3～4次)的患者病死率较低(P<0.05或P<0.01)。在进行TACE治疗的同时联用抗病毒治疗与不联用抗病毒治疗方案的Child-Pugh A级患者生存情况存在明显差异(P=0.003)。多因素分析结果显示,TACE治疗次数(P=0.000)、抗病毒治疗(P=0.000)、胆红素水平(P=0.017)、腹腔转移(P=0.009)、门静脉转移(P=0.004)是TACE治疗的乙型肝炎相关性肝癌患者预后的相关影响因素。结论影响TACE治疗的乙型肝炎相关性肝细胞癌患者预后的独立危险因素可能包括较高胆红素水平、腹腔转移以及门静脉转移,而其保护性因素则可能包括较多的TACE介入治疗的次数以及抗病毒治疗。
Objective To explore the influence factors on the prognosis of patients with hepatitis B-related hepatocellular carcinoma(HCC) treated with transcatheter arterial chemoembolization(TACE).Method A total of 120 patients with hepatitis B-related HCC,who underwent TACE from January 2013 to December 2015,were randomly selected as the study subjects and were followed up until December 2016 to observe one-year survival after treatment.The related prognostic factors of patients were screened and analyzed.Results The univariate analysis showed that antiviral therapy,low aspartate aminotransferase(AST) level(<80 U/L),low serum bilirubin level(<34.2 μmol/L),low Child-Pugh classification,no intra-abdominal metastasis,no pleural metastasis,no portal vein metastasis,younger and more times of interventional treatments were the factors influencing the prognosis of patients(P<0.05 or P<0.01).There was a significant difference in survival condition between patients treated with TACE plus antiviral therapy and patients treated with TACE without antiviral therapy in Child-Pugh A patients(P=0.003).Multivariate analysis showed that the frequency of TACE treatment(P=0.000),antiviral treatment(P=0.000),bilirubin level(P=0.017),peritoneal metastasis(P=0.009),portal vein metastasis(P=0.004) were related to the prognosis of hepatitis B-related HCC patients treated with TACE.Conclusion Higher bilirubin level,intra-abdominal metastasis and portal vein metastasis may be independent risk factors affecting the prognosis of patients with hepatitis B-related HCC treated with TACE,while antiviral therapy and more times of interventional therapies may be the protective factors.
Objective To explore the influence factors on the prognosis of patients with hepatitis B-related hepatocellular carcinoma(HCC) treated with transcatheter arterial chemoembolization(TACE).Method A total of 120 patients with hepatitis B-related HCC,who underwent TACE from January 2013 to December 2015,were randomly selected as the study subjects and were followed up until December 2016 to observe one-year survival after treatment.The related prognostic factors of patients were screened and analyzed.Results The univariate analysis showed that antiviral therapy,low aspartate aminotransferase(AST) level(<80 U/L),low serum bilirubin level(<34.2 μmol/L),low Child-Pugh classification,no intra-abdominal metastasis,no pleural metastasis,no portal vein metastasis,younger and more times of interventional treatments were the factors influencing the prognosis of patients(P<0.05 or P<0.01).There was a significant difference in survival condition between patients treated with TACE plus antiviral therapy and patients treated with TACE without antiviral therapy in Child-Pugh A patients(P=0.003).Multivariate analysis showed that the frequency of TACE treatment(P=0.000),antiviral treatment(P=0.000),bilirubin level(P=0.017),peritoneal metastasis(P=0.009),portal vein metastasis(P=0.004) were related to the prognosis of hepatitis B-related HCC patients treated with TACE.Conclusion Higher bilirubin level,intra-abdominal metastasis and portal vein metastasis may be independent risk factors affecting the prognosis of patients with hepatitis B-related HCC treated with TACE,while antiviral therapy and more times of interventional therapies may be the protective factors.
引文
[1] 王宏利,沙小莹,郭雅玲,等.HBx 与 p300CBP、Smad2蛋白在乙肝相关性肝细胞癌中的表达[J].肝脏,2015,20(4):329-330,339.
[2] 李包根,鄢业鸿,董春华,等.Ⅱ型毛玻璃样肝细胞在乙肝相关性肝细胞癌组织中的表达和意义[J].中华普通外科杂志,2016,31(11):956-957.
[3] Lin YY,Lee RC,Tseng HS,et al.Objective measurement of arterial flow before and after transcatheter arterial chemoembolization:a feasibility study using quantitative color-coding analysis[J].Cardiovasc Inter Rad,2015,38(6):1494-1501.
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[9] 周佳美,向慧玲,吕洪敏,等.预防性抗病毒对TACE治疗的HBVDNA阴性乙肝相关性肝癌的效果[J].天津医药,2013,41(9):875-877.
[10] Bennis Y,Savry A,Correard F,et al.Stability of a highly concentrated solution of epirubicin for conventional transcatheter arterial chemoembolization[J].Int J Pharm,2015,495(2):956-962.
[11] 文宠佩,林志东.肝动脉化疗栓塞联合射频消融术在肝细胞癌中的应用价值[J].中国临床研究,2017,30(12):1653-1655.
[12] 倪俊,袁文斌,岑峰,等.抗病毒治疗在乙肝相关性肝癌术后肝内复发中的作用[J].中华肝胆外科杂志,2015,21(2):91-95.
[13] 朱德东,石小军,王哲,等.射频消融联合肝动脉化疗栓塞对大肝癌患者机体抗肿瘤免疫状态的影响[J].中华全科医学,2018,16(1):38-40.
[14] 黎晓武,李金强,罗向波,等.血清GP73、HSP27联合AFP检测在HBV相关早期肝细胞癌诊断的价值[J].实用预防医学,2016,23(11):1319-1321.
[15] Kokabi N,Camacho JC,Xing M,et al.Immediate post-doxorubicin drug-eluting beads chemoembolization Mr Apparent diffusion coefficient quantification predicts response in unresectable hepatocellular carcinoma:a pilot study[J].J Magn Reson Imaging,2015,42(4):981-989.
[16] 高芸,李少一,商雪莹,等.FAT10过表达对肝癌细胞HepG2侵袭及迁移能力的影响[J].实用预防医学,2013,20(5):517-520.
[17] 陈紫桃,文小燕,易燕桃,等.LAM、ETV抗病毒治疗对伴活动性肝硬化肝癌患者术后的影响[J].肝脏,2014,19(4):268-270.
[18] 林楠,黄娇凤,李建英.核苷(酸)类似物长期治疗失代偿期乙型肝炎肝硬化的Meta分析[J].中国临床研究,2017,30(2):168-174.
[2] 李包根,鄢业鸿,董春华,等.Ⅱ型毛玻璃样肝细胞在乙肝相关性肝细胞癌组织中的表达和意义[J].中华普通外科杂志,2016,31(11):956-957.
[3] Lin YY,Lee RC,Tseng HS,et al.Objective measurement of arterial flow before and after transcatheter arterial chemoembolization:a feasibility study using quantitative color-coding analysis[J].Cardiovasc Inter Rad,2015,38(6):1494-1501.
[4] Wang Z,Chen R,Duran R,et al.Intraprocedural 3D quantification of lipiodol deposition on cone-beam CT predicts tumor response after transarterial chemoembolization in patients with hepatocellular carcinoma[J].Cardiovasc Intervent Radiol,2015,38(6):1548-1556.
[5] 胡其艳,杜珂.乙肝相关性肝细胞癌患者的预防性抗病毒效果[J].国际病毒学杂志,2015,22(6):380-382.
[6] Li Q,Ao GK,Duan F,et al.Incidence and therapeutic frequency of extrahepatic collateral arteries in transcatheter arterial chemoembolization of hepatocellular carcinoma:experience from 182 patients with survival time more than 3 years[J].Eur J Radiol,2015,84(12):2555-2563.
[7] Favelier S,Estivalet L,Pottecher P,et al.Novel imaging biomarkers of response to transcatheter arterial chemoembolization in hepatocellular carcinoma patients[J].Chin J Cancer Res,2015,27 (6):611-626.
[8] 鲁睿,吕卓敏,袁鹏,等.SSBP1在乙肝相关性肝细胞癌中的表达及临床意义[J].现代生物医学进展,2016,16(33):6448-6451,6490.
[9] 周佳美,向慧玲,吕洪敏,等.预防性抗病毒对TACE治疗的HBVDNA阴性乙肝相关性肝癌的效果[J].天津医药,2013,41(9):875-877.
[10] Bennis Y,Savry A,Correard F,et al.Stability of a highly concentrated solution of epirubicin for conventional transcatheter arterial chemoembolization[J].Int J Pharm,2015,495(2):956-962.
[11] 文宠佩,林志东.肝动脉化疗栓塞联合射频消融术在肝细胞癌中的应用价值[J].中国临床研究,2017,30(12):1653-1655.
[12] 倪俊,袁文斌,岑峰,等.抗病毒治疗在乙肝相关性肝癌术后肝内复发中的作用[J].中华肝胆外科杂志,2015,21(2):91-95.
[13] 朱德东,石小军,王哲,等.射频消融联合肝动脉化疗栓塞对大肝癌患者机体抗肿瘤免疫状态的影响[J].中华全科医学,2018,16(1):38-40.
[14] 黎晓武,李金强,罗向波,等.血清GP73、HSP27联合AFP检测在HBV相关早期肝细胞癌诊断的价值[J].实用预防医学,2016,23(11):1319-1321.
[15] Kokabi N,Camacho JC,Xing M,et al.Immediate post-doxorubicin drug-eluting beads chemoembolization Mr Apparent diffusion coefficient quantification predicts response in unresectable hepatocellular carcinoma:a pilot study[J].J Magn Reson Imaging,2015,42(4):981-989.
[16] 高芸,李少一,商雪莹,等.FAT10过表达对肝癌细胞HepG2侵袭及迁移能力的影响[J].实用预防医学,2013,20(5):517-520.
[17] 陈紫桃,文小燕,易燕桃,等.LAM、ETV抗病毒治疗对伴活动性肝硬化肝癌患者术后的影响[J].肝脏,2014,19(4):268-270.
[18] 林楠,黄娇凤,李建英.核苷(酸)类似物长期治疗失代偿期乙型肝炎肝硬化的Meta分析[J].中国临床研究,2017,30(2):168-174.