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肝细胞癌患者伴发糖尿病行肝动脉化疗栓塞术的预后因素分析
引用本文:刘光华,俞炬明,范国平,董国芳,王瑞芝,汪登斌,欧阳强.肝细胞癌患者伴发糖尿病行肝动脉化疗栓塞术的预后因素分析[J].介入放射学杂志,2017,26(10).
作者姓名:刘光华  俞炬明  范国平  董国芳  王瑞芝  汪登斌  欧阳强
作者单位:1. 200092,上海交通大学医学院附属新华医院放射介入科;2. 200092,上海交通大学医学院附属新华医院放射科
摘    要:目的 分析糖尿病(DM)对不可切除肝细胞癌(HCC)患者TACE术后预后的影响.方法 选取2010年1月-2015年6月就诊于上海交通大学医学院附属新华医院行TACE术的HCC患者858例,其中合并DM患者175例(DM组),HCC未合并DM患者683例(非DM组),分析两组患者一般临床资料及总体生存的差异.生存率用Kaplan-Meier法计算,组间差异采用Log-Rank方法,采用Cox比例风险回归分析不可切除HCC患者TACE术预后的影响因素.结果 两组性别、年龄、血清总胆红素、白蛋白、凝血酶原时间、甲胎蛋白(AFP)、Child-Pugh分级、肿瘤最大直径和数目、肝硬化、TACE治疗次数以及BCLC分期比较,差异均无统计学意义(P>0.05);DM组空腹血糖(FPG)水平高于非DM组(P<0.05).DM组患者1、3、5年生存率为60.9%、27.5%和10.7%,非DM组为70.9%、36.0%和17.6%,经Log-rank检验,差异存在统计学意义(P=0.008).将上述变量进行多因素Cox比例风险回归分析结果显示,肿瘤最大直径>5 cm、肿瘤数目多发、AFP>20 ng/ml、BCLC分期、以及合并DM是影响HCC患者TACE预后的独立危险因素.结论 DM是影响不可切除HCC患者TACE后独立危险因素.

关 键 词:肝细胞癌  肝动脉栓塞化疗  糖尿病  预后

Analysis of prognostic factors in patients with hepatocellular carcinoma complicated by diabetes mellitus after transcatheter arterial chemoembolization
LIU Guanghua,YU Juming,FAN Guoping,DONG Guofang,WANG Ruizhi,WANG Dengbin,OUYANG Qiang.Analysis of prognostic factors in patients with hepatocellular carcinoma complicated by diabetes mellitus after transcatheter arterial chemoembolization[J].Journal of Interventional Radiology,2017,26(10).
Authors:LIU Guanghua  YU Juming  FAN Guoping  DONG Guofang  WANG Ruizhi  WANG Dengbin  OUYANG Qiang
Abstract:Objective To analyze the effect of diabetes mellitus (DM) on the prognosis of patients with unresectable hepatocellular carcinoma (HCC) after receiving transcatheter arterial chemoembolization (TACE).Methods A total of 858 HCC patients,who were admitted to the Affiliated Xinhua Hospital,School of Medicine,Shanghai Jiaotong University,China,during the period from January 2010 to June 2015 to receive TACE,were selected.Among the 858 HCC patients,175 patients suffered from coexisting DM (DM group) and 683 patients had no DM (non-DM group).The differences in general clinical data and overall survival between the two groups were analyzed.Kaplan-Meier method was used to calculate the survival rate,the difference between the two groups was evaluated by log-rank method,and Cox proportional hazards regression was adopted to analyze the prognostic factors of HCC patients after receiving TACE.Results There were no statistically significant differences in sex,age,serum albumin,total bilirubin,prothrombin time,alpha fetoprotein (AFP),Child-Pugh grade,tumor size and number,cirrhosis,number of TACE treatment times and BCLC staging between the two groups (P>0.05);the fasting blood glucose (FPG)level in DM group was higher than that in non-DM group (P<0.05).The 1-,3-and5-year survival rates of the DM group were 60.9%,27.5% and 10.7% respectively,which were 70.9%,36.0% and 17.6% respectively in the non-DM group;the Log-rank test showed that the difference between the two groups was statistically significant (P=0.008).Multivariate Cox proportional hazard regression analysis revealed that the largest tumor diameter >5 cm,multiple tumor lesions,AFP>20 ng/ml,BCLC stage and coexisting DM were independent risk factors that affected the prognosis of HCC patients after receiving TACE.Conclusion The coexisting DM is an independent risk factor that may affect the prognosis of patients with inoperable HCC after receiving TACE.
Keywords:hepatocellular carcinoma  transcatheter arterial chemoembolization  diabetes mellitus  prognosis
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