肝动脉化疗栓塞联合射频消融治疗巴塞罗那分期中晚期肝癌的预后影响因素分析

胡舟朝; 王和平; 严金岗; 张国强

doi:10.16766/j.cnki.issn.1674-4152.002632

肝动脉化疗栓塞联合射频消融治疗巴塞罗那分期中晚期肝癌的预后影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002632

1.
温州医科大学附属舟山医院介入诊疗中心，浙江舟山 316021
2.
温州医科大学附属舟山医院放射诊断中心
3.
温州医科大学附属舟山医院肝胆外科

基金项目:

浙江省基础公益研究计划项目 LGF21H160020

舟山市科技计划项目 2017C31099

详细信息

通讯作者:
胡舟朝, E-mail: youbixinxin@163.com

中图分类号: R735.7 R730.58
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- 文章访问数: 181
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- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2021-08-05
- 网络出版日期: 2022-11-29

Prognostic factors of transarterial chemoembolization combined with radiofrequency ablation for advanced Barcelona clinic liver cancer

1.
Interventional Diagnosis and Treatment Center, Affiliated Zhoushan Hospital of Wenzhou Medical University, Zhoushan, Zhejiang 316021, China

摘要

摘要: 目的探讨肝动脉化疗栓塞(the arterial chemoembolization，TACE)联合射频消融(radiofrequency ablation，RFA)治疗巴塞罗那分期(Barcelona clinic liver cancer，BCLC)中晚期原发性肝癌(hepatocellular carcinoma，HCC)患者预后的影响因素。方法回顾性分析2013年2月—2015年2月在温州医科大学附属舟山医院行TACE联合RFA治疗的76例BCLC中晚期HCC患者的临床资料。采用Kaplan-Meier法单因素分析和Cox多因素回归分析探究影响患者中位总体生存期(overall survival，OS)和中位无疾病进展生存期(progression-free survival，PFS)的相关因素。结果 76例患者中位OS为27个月(11~68个月)，中位PFS为15个月(4~63个月)。Kaplan-Meier法单因素分析结果显示，体能状态(PS)评分、肝功能Child-Pugh分级、肿瘤个数、肿瘤直径、门静脉癌栓、甲胎蛋白、替吉奥治疗以及RFA治疗次数与中位OS相关(均P＜0.05)；肝功能Child-Pugh分级、肿瘤个数、肿瘤直径、门静脉癌栓、替吉奥治疗以及RFA治疗次数与中位PFS相关(均P＜0.05)；Cox多因素分析结果显示，肿瘤直径增大、有门静脉癌栓为患者OS和PFS的独立危险因素(均P＜0.05)，多次RFA治疗、替吉奥治疗为PFS的独立保护因素(均P＜0.05)。结论口服替吉奥、增加RFA治疗次数对控制TACE联合RFA治疗的BCLC中晚期HCC患者的肿瘤进展具有重要帮助，而肿瘤直径增加、门静脉癌栓是影响患者预后的独立危险因素，临床应采取相应措施进行防治。
- 肝动脉化疗栓塞 /
- 射频消融 /
- 肝癌 /
- 预后 /
- 影响因素
Abstract: Objective To investigate the prognostic factors of the arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in the treatment of patients with advanced hepatocellular carcinoma (HCC) at Barcelona Clinic stage (BCLC). Methods The clinical data of 76 patients with advanced HCC with BCLC who received TACE combined with RFA treatment in our hospital from February 2013 to February 2015 were retrospectively analysed. Kaplan-Meier univariate analysis and Cox multivariate regression were used to analyse the factors affecting overall survival (OS) and progression-free survival (PFS) of patients. Results The median OS was 27 months (11 - 68 months), and the median PFS was 15 months (4 - 63 months) in the 76 patients. Kaplan-Meier univariate analysis showed that physical status (PS) score, Child-Pugh grade of liver function, tumour number, tumour diameter, portal vein tumour thrombus, alpha foetal protein, Teggio treatment and times of RFA treatment were closely correlated with median OS (all P < 0.05). Liver function Child-Pugh grade, tumour number, tumour diameter, portal vein tumour thrombus, Teggio treatment and the frequency of RFA treatment were significantly correlated with median PFS (all P < 0.05). Cox multivariate analysis showed that enlargement of tumour diameter and portal vein tumour emboli were independent risk factors for OS and PFS (all P < 0.05), and multiple RFA treatment and Teggio treatment were independent protective factors for PFS (all P < 0.05). Conclusion Oral administration of Teggio and increasing the number of RFA treatments are of great help to control the tumour progression in BCLC patients with middle and advanced HCC treated with TACE combined with RFA. However, increase in tumour diameter and portal venous cancer thromboembolism are independent risk factors affecting the prognosis of patients, and corresponding measures should be adopted for clinical prevention and treatment.
- Transarterial chemoembolization /
- Radiofrequency ablation /
- Liver cancer /
- Prognosis /
- Influencing factor

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表 1 影响HCC患者生存预后的单因素分析(x ±s, 月)

Table 1. Univariate analysis of influence on survival and prognosis of HCC patients (x ±s, months)

项目	例数	中位OS	t值	P值	中位PFS	t值	P值
PS评分			5.813	< 0.001		1.884	0.063
0~1分	55	29.13±2.87			14.75±1.79
2分	21	24.83±2.92			13.89±1.75
肿瘤位置			1.072	0.287		1.087	0.281
单叶	66	28.26±2.81			14.16±1.81
双叶	10	27.45±2.96			14.83±1.86
AFP			16.716	< 0.001		3.989	0.076
阴性	37	35.87±3.62			22.78±3.85
阳性	39	23.65±2.71			18.69±2.82
Child-Pugh分级			24.267	< 0.001		23.119	< 0.001
A级	52	33.83±2.62			21.58±1.71
B级	24	17.68±2.89			11.68±1.79
肿瘤个数			25.546	< 0.001		16.858	< 0.001
单发	39	33.83±2.62			20.26±2.27
多发	37	17.68±2.89			11.59±2.21
肿瘤直径			26.023	< 0.001		34.043	< 0.001
3~5 cm	27	35.68±3.47			24.32±1.31
>5 cm	49	19.72±1.89			11.42±1.71
门静脉癌栓			32.261	< 0.001		44.177	< 0.001
无	43	35.75±2.72			25.78±1.62
有	33	17.78±1.92			8.63±1.75
替吉奥治疗			26.254	< 0.001		30.699	< 0.001
无	25	17.93±2.71			8.48±1.92
有	51	35.78±2.82			22.82±1.91
RFA次数			26.551	< 0.001		45.023	< 0.001
单次	23	17.69±2.93			8.71±1.37
多次	53	36.79±2.86			22.72±1.19

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表 2 影响HCC患者预后生存的Cox多因素分析变量赋值

Table 2. Variable assignment of Cox multivariate analysis affecting the prognosis and survival of HCC patients

变量	赋值方法
PS评分	1分=1, 2分=2, 3分=3
AFP	阴性=1，阳性=2
Child-Pugh分级	A级=1，B级=2
肿瘤个数	单个=1，多个=2
肿瘤直径	3~5 cm=1，>5 cm=2
门静脉癌栓	无=0，有=1
替吉奥治疗	无=0，有=1
RFA次数	单次=1，多次=2

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表 3 影响HCC患者OS的Cox多因素回归分析

Table 3. Cox multivariate regression analysis of OS in HCC patients

变量	B	SE	Wald χ²	P值	HR值	95% CI
肿瘤直径	1.728	0.387	5.326	0.021	5.628	2.636~12.216
门静脉癌栓	1.336	0.661	9.891	0.002	3.803	1.041~13.892

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表 4 影响HCC患者PFS的Cox多因素回归分析

Table 4. Cox multivariate regression analysis of PFS in HCC patients

变量	B	SE	Wald χ²	P值	HR值	95% CI
肿瘤直径	0.912	0.365	4.926	0.026	2.489	1.217~5.090
门静脉癌栓	1.556	0.652	9.793	0.002	4.739	1.321~17.007
替吉奥治疗	-0.231	0.035	13.472	< 0.001	0.794	0.741~0.850
RFA次数	-0.873	0.095	11.527	0.001	0.418	0.347~0.501

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