不同治疗方式对原发性肝癌预后的影响及危险性因素分析
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摘要
目的探讨不同治疗方式对原发性肝癌预后的影响以及肝癌术后生存期相关危险性因素的分析。方法选取我院收治的原发性肝癌患者71例,根据病情及患者意愿分别进行手术治疗、介入化疗以及姑息治疗。观察治疗后患者的并发症发生情况以及术后生存情况。结果手术组半年、1年、2年生存率分别为88%(36/41)、66%(27/41)、44%(18/41),介入组分别为80%(20/25)、52%(13/25)、8%(2/25);姑息组分别为100%(5/5)、80%(4/5)、0%(0/5)。三组患者的2年生存率比较,差异有统计学意义(P<0.05)。三组患者的主要并发症为低蛋白血症、胸腹腔积液,发生率无明显差异(P>0.05)。年龄、乙肝病毒感染史、饮酒史对三组患者2年生存率的影响比较,差异有统计学意义(P<0.05)。结论采用手术治疗的原发性肝癌患者长期生存率显著高于介入治疗,但结合长期经验,考虑手术联合化疗的治疗效果更好;年龄、饮酒史对原发性肝癌患者的生存率具有显著影响。
Objective To explore the effect of different treatment methods on the prognosis of primary liver cancer and analyze the risk factors related to the survival of patients with liver cancer after surgery. Methods Seventy-one patients with primary liver cancer in our hospital were treated with surgical treatment, interventional chemotherapy or conservative treatment according to the condition and patients' wishes. The complications and postoperative survival were observed after different treatments. Results The half-year, 1-year and2-year survival rate of the surgical treatment group was respectively 88%(36/41), 66%(27/41) and 44%(18/41). That of the interventional chemotherapy group was respectively 80%(20/25), 52%(13/25) and 8%(2/25). That of the conservative treatment group was respectively100%(5/5), 80%(4/5) and 0%(0/5). There was significant difference in the 2-year survival rate between the three groups(P<0.05). The main complications in the three groups included hypoproteinemia and pleural effusion, but no significant differences were found in their incidences between the groups(P>0.05). Age, HBV history and drinking history were observed to have a significant effect on the 2-year survival rate(P<0.05). Conclusion The long-term survival rate of primary liver cancer patients with surgical treatment was higher than that of patients with interventional chemotherapy. Surgery combined with intraoperative chemotherapy could be considered as a more effective treatment. Age and drinking history had significant effect on postoperative survival of primary liver cancer.
Objective To explore the effect of different treatment methods on the prognosis of primary liver cancer and analyze the risk factors related to the survival of patients with liver cancer after surgery. Methods Seventy-one patients with primary liver cancer in our hospital were treated with surgical treatment, interventional chemotherapy or conservative treatment according to the condition and patients' wishes. The complications and postoperative survival were observed after different treatments. Results The half-year, 1-year and2-year survival rate of the surgical treatment group was respectively 88%(36/41), 66%(27/41) and 44%(18/41). That of the interventional chemotherapy group was respectively 80%(20/25), 52%(13/25) and 8%(2/25). That of the conservative treatment group was respectively100%(5/5), 80%(4/5) and 0%(0/5). There was significant difference in the 2-year survival rate between the three groups(P<0.05). The main complications in the three groups included hypoproteinemia and pleural effusion, but no significant differences were found in their incidences between the groups(P>0.05). Age, HBV history and drinking history were observed to have a significant effect on the 2-year survival rate(P<0.05). Conclusion The long-term survival rate of primary liver cancer patients with surgical treatment was higher than that of patients with interventional chemotherapy. Surgery combined with intraoperative chemotherapy could be considered as a more effective treatment. Age and drinking history had significant effect on postoperative survival of primary liver cancer.
引文
[1]吕桂帅,陈磊,王红阳.我国肝癌研究的现状与前景[J].生命科学, 2015, 27(03):237-248. doi:10.13376/j.cbls/2015034.
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[10]Xuan ZD, Zhou L, Wang Y, et al. Prognostic value of the combination of serum levels of vascular endothelial growth factor, C-reactive protein and contrast-enhanced ultrasound in patients with primary liver cancer who underwent transcatheter arterial chemoembolization[J]. Expert Rev Anticancer Ther, 2017, 17(12):1169-1178. doi:10.1080/14737140.2017.1395284.
[11]张金梁,翟博,方泰石,等.晚期肝癌和复发性肝癌治疗的研究进展[J].现代生物医学进展, 2016, 16(2):358-361. doi:10.13241/j. cnki. pmb.2016.02.042.
[12]Hagymasi K, Tulassay Z. Epidemiology, risk factors and molecular pathogenesis of primary liver cancer[J]. Orv Hetil, 2008, 149(12):541-548. doi:10.1556/OH.2008.28313.
[13]苗润晨,许鑫森,陈伟,等.年龄因素对肝癌肝切除术患者长期预后的影响[J].现代肿瘤医学, 2014, 22(5):1123-1126. doi:10.3969/j. issn.1672-4992.2014.05.44
[14]Cohen C, Caballero J, Martin M, et al. Eradication of hepatitis B:a nationwide community coalition approach to improving vaccination, screening, and linkage to care[J].J Community Health, 2013, 38(5):799-804. doi:10.1007/s10900-013-9699-4.
[15]Yang HI, Yeh SH, Chen PJ, et al. Associations between hepatitis B virus genotype and mutants and the risk of hepatocellular carcinoma[J]. J Natl Cancer Inst, 2008, 100(16):1134-1143. doi:10.1093/jnci/djn243.
[16]Zhao P, Zheng JS, Zhang HH, et al. Efficacy evaluation and exploration of TACE combined with CT-guided precision microwave ablation treatment for primary liver cancer[J].Zhonghua Zhong Liu Za Zhi, 2016, 38(2):138-145. doi:10.3760/cma. j. issn.0253-3766.2016.02.012.
[17]Thomson JP, Ottaviano R, Unterberger EB, et al. Loss of Tet1-Associated 5-Hydroxymethylcytosine Is Concomitant with Aberrant Promoter Hypermethylation in Liver Cancer[J]. Cancer Res, 2016, 76(10):3097-3108. doi:10.1158/0008-5472. CAN-15-1910.
[18]Li A, Ma S, Pawlik T, et al. Surgical treatment of double primary liver cancer:An observational study for a rare type of tumor[J]. Medicine(Baltimore), 2016, 95(32):e4412. doi:10.1097/MD.0000000000004412.
[2]Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide:sources, methods and major patterns in GLOBOCAN 2012[J]. Int J Cancer, 2015, 136(5):E359-E386. doi:10.1002/ijc.29210.
[3]王丹霞,全文婕,史晓欣,等.肝癌早期诊断标志物及其检测方法的研究进展[J].肿瘤药学, 2016, 6(1):15-20.doi:10.3969/j. issn.2095-1264.2016.01.04.
[4]戴朝六,赵阳.原发性肝癌的综合治疗[J].中国普外基础与临床杂志, 2014, 21(2):133-137. doi:10.7507/1007-9424.20140031.
[5]Li J, Zhu WL, Kang XX, et al. Prognostic factors and model of primary liver cancer treated with transcatheter arterial chemoembolization combined with radiofrequency ablation[J]. Zhonghua Zhong Liu Za Zhi, 2017, 39(10):787-791.doi:10.3760/cma. j. issn.0253-3766.2017.10.013.
[6]Zhang D, Xu A. Application of dual-source CT perfusion imaging and MRI for the diagnosis of primary liver cancer[J]. Oncol Lett, 2017, 14(5):5753-5758. doi:10.3892/ol.2017.6170.
[7]Cong WM, Bu H, Chen J, et al. Practice guidelines for the pathological diagnosis of primary liver cancer:2015 update[J]. World J Gastroenterol, 2016, 22(42):9279-9287.
[8]Liao YH, Lin CC, Lai HC, et al. Adjunctive traditional Chinese medicine therapy improves survival of liver cancer patients[J]. Liver Int, 2015, 35(12):2595-2602. doi:10.1111/liv.12847.
[9]Sun W, Ding XY, Chen JL, et al. The combination of percutaneous iohexol-ethanol injection with radiofrequency ablation for the treatment of primary liver cancer in highrisk locations[J]. Zhonghua Zhong Liu Za Zhi, 2017, 39(9):695-700. doi:10.3760/cma. j. issn.0253-3766.2017.09.011.
[10]Xuan ZD, Zhou L, Wang Y, et al. Prognostic value of the combination of serum levels of vascular endothelial growth factor, C-reactive protein and contrast-enhanced ultrasound in patients with primary liver cancer who underwent transcatheter arterial chemoembolization[J]. Expert Rev Anticancer Ther, 2017, 17(12):1169-1178. doi:10.1080/14737140.2017.1395284.
[11]张金梁,翟博,方泰石,等.晚期肝癌和复发性肝癌治疗的研究进展[J].现代生物医学进展, 2016, 16(2):358-361. doi:10.13241/j. cnki. pmb.2016.02.042.
[12]Hagymasi K, Tulassay Z. Epidemiology, risk factors and molecular pathogenesis of primary liver cancer[J]. Orv Hetil, 2008, 149(12):541-548. doi:10.1556/OH.2008.28313.
[13]苗润晨,许鑫森,陈伟,等.年龄因素对肝癌肝切除术患者长期预后的影响[J].现代肿瘤医学, 2014, 22(5):1123-1126. doi:10.3969/j. issn.1672-4992.2014.05.44
[14]Cohen C, Caballero J, Martin M, et al. Eradication of hepatitis B:a nationwide community coalition approach to improving vaccination, screening, and linkage to care[J].J Community Health, 2013, 38(5):799-804. doi:10.1007/s10900-013-9699-4.
[15]Yang HI, Yeh SH, Chen PJ, et al. Associations between hepatitis B virus genotype and mutants and the risk of hepatocellular carcinoma[J]. J Natl Cancer Inst, 2008, 100(16):1134-1143. doi:10.1093/jnci/djn243.
[16]Zhao P, Zheng JS, Zhang HH, et al. Efficacy evaluation and exploration of TACE combined with CT-guided precision microwave ablation treatment for primary liver cancer[J].Zhonghua Zhong Liu Za Zhi, 2016, 38(2):138-145. doi:10.3760/cma. j. issn.0253-3766.2016.02.012.
[17]Thomson JP, Ottaviano R, Unterberger EB, et al. Loss of Tet1-Associated 5-Hydroxymethylcytosine Is Concomitant with Aberrant Promoter Hypermethylation in Liver Cancer[J]. Cancer Res, 2016, 76(10):3097-3108. doi:10.1158/0008-5472. CAN-15-1910.
[18]Li A, Ma S, Pawlik T, et al. Surgical treatment of double primary liver cancer:An observational study for a rare type of tumor[J]. Medicine(Baltimore), 2016, 95(32):e4412. doi:10.1097/MD.0000000000004412.