150例原发性肝癌的不同治疗手段的临床预后因素分析
摘要
目的:评价目前肝癌的三种常见治疗方法的生存率情况,以进一步探讨原发性肝癌治疗方式的最佳选择。方法:回顾性分析我院150例原发性肝癌的病历资料,其中,介入组(A组)62);介入加手术组(TACE+surgery TACE+S)(B组)64例,行手术后介入治疗,部分肿块较大的病例先行介入,待分期降级或肿块缩小后再手术治疗,手术行肝叶或肝段切除,介入仍采用肝动脉插管栓塞化疗;介入加放疗组(C组)24例,介入后再行肿块局部三维适形放疗(3-dimensional conformal radiotherapy 3-DCRT),介入仍采用肝动脉插管栓塞化疗,即TACE+3-DCRT组。率的检验采用列联表χ2检验,生存分析用Kaplan-Meier法,生存率比较采用Log-rank检验。结果:6月、1年、2年、3年生存率:介入组88.7%(55/62)、71%(44/62)、45.2%(20/44)、21.4%(6/28);介入加手术组100%(64/64)、92.2%(59/64)、72.9%(43/59)、53.2%(25/47);介入加放疗组100%(24/24)、83.3%(20/24)、60%(12/20)、46.7%(7/15)。三组治疗方法生存率列联表χ2检验均有显著性差异(P<0.05)。两两比较四格表χ2检验,A组与B组有显著性差异(P<0.05/3=0.0167);三组治疗方法生存分析Kaplan-Meier法检验有显著性差异(P=0.001),A、B和C组治疗方法的中位生存时间分别为24、44和32月,两两比较Log-rank检验,A组与B组有显著性差异(P=0.000)。结论:原发性肝癌的治疗在以介入治疗基础上联合手术、放疗等综合治疗较单纯介入治疗的远期生存率明显提高,介入+手术组生存率明显高于其他两组,从生存曲线图来看,三种疗法生存率比较:介入联合手术组>介入联合放疗组>单纯介入组。
Objective: to evaluate survival rate condition of current three frequent treatment modalities for primary liver cancer,in order to discuss advancedly the best selection about therapy method for liver cancer .Methods: a retrospective analysis of 150 patients of PLC received three frequent treatments our hospital,among them ,62 cases which were included in intervention group were treated with transcatheter hepatic chemo- embolization ( TACE)(A group);64 cases were in TACE+surgery(TACE+S) (B group),to go on intervention treatment after surgery,or in some cases with larger tumor, to go on intervention treatment before surgery, waiting tumor stage is downgraded,or tumor is contracted. To go on resection of liver lobe or segments of liver, intervention way is still transcatheter hepatic chemo-embolization; 24 cases included TACE+Radiotherapy (TACE+RT) (C group),after TACE,go on 3-dimensional conformal radiotherapy (3-DCRT) for hepatocellular local tumor.The test of rate uses Row-Column tablesχ2 test, survival rates were assessed from the date of the beginning of treatment using the Kaplan-Meier method. The survival rates of three groups were compared using Log-rank. Results:6 monthes,1 year,2 years,3 years survival rate: 88.7%(55/62)、71%(44/62)、45.2%(20/44)、21.4%(6/28) in TACE group, 100%(64/64)、92.2%(59/64)、72.9%(43/59)、53.2%(25/47) in TACE+S group and 100%(24/24)、83.3%(20/24)、60%(12/20)、46.7%(7/15) in TACE+RT group. The Row-Column tableχ2 tests of overall survival rates for three frequent treatment modalities were all significantly different(P<0.05).The 4th-Cell tableχ2 tests of the 2-2 analysis among survival rates for three frequent treatment modalities were significantly different only between A and B group(P<0.05/3=0.0167).The survival analysis of three therapic groups using the Kaplan-Meier method was significantly different among A、B and C group(P=0.001). Means for Survival Time among the A、B and C therapy groups were 24、44and 32 monthes respectively The Log-Rank tests of the 2-2 analysis among three groups were significantly different only between A and B group(P=0.000). Conclusions: the survival rates of the TACE therapy combined with S or RT was significantly higher than the single TACE between the comprehensive treatments of PLC on the base of the TACE therapy. the survival rates of the TACE+S were greatly highest among three groups. According to survival plot, among the survival rates of three groups, TACE+S group> TACE+RT group> TACE group.
Objective: to evaluate survival rate condition of current three frequent treatment modalities for primary liver cancer,in order to discuss advancedly the best selection about therapy method for liver cancer .Methods: a retrospective analysis of 150 patients of PLC received three frequent treatments our hospital,among them ,62 cases which were included in intervention group were treated with transcatheter hepatic chemo- embolization ( TACE)(A group);64 cases were in TACE+surgery(TACE+S) (B group),to go on intervention treatment after surgery,or in some cases with larger tumor, to go on intervention treatment before surgery, waiting tumor stage is downgraded,or tumor is contracted. To go on resection of liver lobe or segments of liver, intervention way is still transcatheter hepatic chemo-embolization; 24 cases included TACE+Radiotherapy (TACE+RT) (C group),after TACE,go on 3-dimensional conformal radiotherapy (3-DCRT) for hepatocellular local tumor.The test of rate uses Row-Column tablesχ2 test, survival rates were assessed from the date of the beginning of treatment using the Kaplan-Meier method. The survival rates of three groups were compared using Log-rank. Results:6 monthes,1 year,2 years,3 years survival rate: 88.7%(55/62)、71%(44/62)、45.2%(20/44)、21.4%(6/28) in TACE group, 100%(64/64)、92.2%(59/64)、72.9%(43/59)、53.2%(25/47) in TACE+S group and 100%(24/24)、83.3%(20/24)、60%(12/20)、46.7%(7/15) in TACE+RT group. The Row-Column tableχ2 tests of overall survival rates for three frequent treatment modalities were all significantly different(P<0.05).The 4th-Cell tableχ2 tests of the 2-2 analysis among survival rates for three frequent treatment modalities were significantly different only between A and B group(P<0.05/3=0.0167).The survival analysis of three therapic groups using the Kaplan-Meier method was significantly different among A、B and C group(P=0.001). Means for Survival Time among the A、B and C therapy groups were 24、44and 32 monthes respectively The Log-Rank tests of the 2-2 analysis among three groups were significantly different only between A and B group(P=0.000). Conclusions: the survival rates of the TACE therapy combined with S or RT was significantly higher than the single TACE between the comprehensive treatments of PLC on the base of the TACE therapy. the survival rates of the TACE+S were greatly highest among three groups. According to survival plot, among the survival rates of three groups, TACE+S group> TACE+RT group> TACE group.
引文
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[31]梁安民,莫钦国,原发性肝癌的综合治疗-附607例报告[J].癌症,2004,23(2): 211-214
[32] Dodd G D, Soulen M C, Kane R A, et al. Minimally invavivetreatment of malignant hepatic tumors: at the threshold of amajor breakthrough. Radiograpgics, 2000,20(1):9
[33] Philips R,Murikami K. Primary neoplasms of the liver:results of radiation therapy. Cancer,1960,13:714-719
[34]汪小浪,郑莉萍等.原发性肝癌肝动脉化疗栓塞术后序贯应用三维适行放疗的临床研究[J].实用临床医学2006,7(7):22
[35]郭伟建,于尔辛,易成,等.肝动脉化疗栓塞结合外照射治疗大肝癌的预后因素分析[J].中华肝脏病杂志,2002,10(3):167-169
[36] Seong J,Park HC,Han KH,et al. Local radiotherapy for unresectable hepatocellular carcinoma patients who failed with transcatheter arterial chemoembolization[J]. Int J Radiat Oncol BiolPhy,2000,47:1331-1335
[37]冷祝强,梁赵玉等.肝癌介入治疗放射治疗及综合治的疗效分析[J].中华放射肿瘤学杂志,2000,9(2):99-101
[2] Parkin FDM.Global cancer statistics in the year 2000 Lancet[J] oncol.2001. 2.(9):533
[3] Sturm JW, Keese M. Multimodal treatment of hepatocellular carcinoma (HCC) [J]. Oncology, 2004, 27:294
[4] Hemming AW, Reed AI, LanghamMR Jr,et al. Combined resection of the liver and inferior vena cava for hepatic malignancy[J]. Ann Surg,2004, 239:712
[5] Jaeck D, Bachellier P, Oussoultzoglou E,et al. Surgical resection of hepatocellular carcinoma. Post-operative outcome and long-term results in Europe: an overview [J]. Liver Transpl, 2004, 10:58
[6] Poon RT, Fan ST. Hepatectomy for hepatocellular carcinoma: patient selection and postoperative outcome[J]. Liver Transpl, 2004, 10:39
[7] Zhou XD. Recurrence and metastasis of hepatocellular carcinoma:progress and prospects[J]. Hepatobiliary Pancreat Dis Int, 2002, 1:35
[8] Grazi GL, CesconM, Ravaioli M,et al. Liver resection for hepatocellular carcinoma in cirrhotics and noncirrhotics. evaluation of clinicopathologic features and comparison of risk factors forlong-term survival and tumour recurrence in a single centre[J]. Aliment Pharmacol Ther,2003, 17:119
[9]孙燕,石凯.肝癌综合性介入治疗规范化方案(草案) .临床肿瘤内科手册-5版[M].人民卫生出版社2007.9:224
[10]梁安民,莫钦国,原发性肝癌的综合治疗-附607例报告[J].癌症2004. 23(2): 211-214
[11] Dodd G D, Soulen M C, Kane R A, et al. Minimally invavivetreatment of malignant hepatic tumors: at the threshold of amajor breakthrough[J]. Radio grapgics, 2000, 20(1): 9
[12] Philips R,Murikami K. Primary neoplasms of the liver:results of radiation therapy [J]. Cancer,1960,13:714-719
[13]汪小浪,郑莉萍,等.原发性肝癌肝动脉化疗栓塞术后序贯应用三维适行放疗的临床研究[J].实用临床医学2006,7(7):22
[14]郭伟建,于尔辛,易成,等.肝动脉化疗栓塞结合外照射治疗大肝癌的预后因素分析[J].中华肝脏病杂志,2002,10(3):167-169
[15] Seong J,Park HC,Han KH,et al. Local radiotherapy for unresectable hepatocellular carcinoma patients who failed with transcatheter arterial chemoembolization[J]. Int J Radiat Oncol BiolPhy,2000,47:1331-1335
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