终末期肝病模型对原发性肝癌患者行经导管动脉化疗栓塞术的指导意义

目的探讨运用终末期肝病模型（MELD）判断原发性肝癌患者肝脏储备功能是否适合行经导管动脉化疗栓塞术（TACE）的临床意义。方法回顾性分析163例首次行TACE治疗的不能切除原发性肝癌住院患者的资料，从MELD评分、临床生化指标、肿瘤淋巴结转移fTNM）分期、病因等方面研究影响患者TACE术后生存的因素。log-rank检验进行生存单因素分析，Cox比例风险模型进行生存多因素分析。结果单因素分析显示，年龄、性别、TNM分期等19项因素与患者生存相关；MELD评分〈10分与≥10分患者间的生存时间差异有统计学意义（P=0．015）。多因素分析显示，年龄、性别、TNM分期、血清前白蛋白和中药治疗是影响患者生存的独立因素，其中仅中药治疗是影响患者生存的保护性因素。结论MELD评分对原发性肝癌患者是否适合行TACE治疗具有一定的指导意义；当患者的MELD评分≥10分时，行TACE治疗需谨慎。

Value of model for end-stage liver disease score for predicting survival in primary hepatic cancer patients treated with trans-catheter arterial chemoembolisation

Objective To investigate the value of model for end-stage liver disease （MELD） score for predicting survival in primary hepatic cancer （PHC） patients treated with trans-catheter arterial chemoembolisation （TACE）. Methods A total of 163 patients with irremovable PHC were enrolled into the study, and they were initially treated with TACE for PHC from January 2005 to March 2009. MELD score was calculated for each patient following the original formula on the first day of admission. All patients were followed up at least 1 year. The following factors such as MELD score, child-turcotte-pugh score, clinic biochemistry parameters, tumor node metastases （TNM） staging system and causes of PHC were analyzed. Survival curves were plotted with the Kaplan-Meier method and were compared by using a log-rank test. Univariate and multivariable proportional hazards analyses were used to determine the relationship between risk factors and mortality. Results By univariate analysis, 19 factors were associated with higher mortality in patients with PHC. The patients whose MELD score were ≥10 would have a poor probability of survival according to univariate analysis （X2=5.974, P=0.015）. According to multivariable analysis, age, gender, TNM staging system, serum prealbumin, and treatment with traditional Chinese medicine （TCM） could quantify the risk of mortality in patients with irremovable PHC, independent of the procedure performed. Only the treatment with TCM was the significant favorable prognostic factor. Conclusion MELD is a feasible predictive model for patients with PHC undergoing TACE. Patients with a MELD score ≥10, TACE must be planned with a great deal of caution because of the poor probability of survival.