综合治疗策略对我国丙型肝炎相关性肝癌患者的预后因素分析

目的评价单纯应用经导管动脉内化疗（TACE）及综合治疗丙型肝炎相关性肝细胞癌（HCV-HCC）的临床疗效、生存状况及预后分析。 方法回顾性分析2008年8月至2011年12月解放军总医院介入放射科收治的139例丙型肝炎相关性肝癌患者，按照治疗方式不同，分为单纯TACE治疗组96例（TACE组）和TACE-联合治疗组43例，分析其生存情况及预后因素。 结果TACE组患者的1、2和3年生存率分别为79.2%、43.8%和24.0%；综合治疗组患者的1、2和3年生存率分别为86.0%、76.7%和58.1%。TACE组与综合治疗组在生存率方面，差异具有统计学意义（χ² = 8.691，P = 0.003）。单因素分析结果显示，Child分级、有无门脉癌栓、甲胎蛋白（AFP）、肿瘤大小、肿瘤数目、美国东部肿瘤协作组（ECOG）评分、治疗方式及巴塞罗那临床肝癌（BCLC）分期均为影响丙型肝炎相关性肝癌患者长期生存的危险因素。Cox回归分析结果显示，肿瘤大小、治疗方式、BCLC分期、有无门脉癌栓和AFP水平是丙型肝炎相关性HCC患者预后的独立危险因素，差异均具有统计学意义（P均< 0.05）。 结论综合治疗丙型肝炎相关性肝癌是延长患者生存期有效的治疗方法。

Efficacy and prognostic factors of transarterial chemoembolization combined with multimodality treatments strategies for hepatitis C virus-related hepatocellular carcinoma in China

ObjectiveTo evaluate the efficacy, survival and prognosis of transarterial chemoembolization (TACE) alone and TACE in combination with multimodality therapy for the hepatitis C virus-related hepatocellular carcinoma (HCV-HCC). MethodsThe clinical data of 139 patients with HCV-HCC treated in PLA General Hospital from August 2008 to December 2011 were analyzed, retrospectively. Among them, 96 patients were treated with TACE alone (TACE group) and 43 patients treated with TACE plus multimodality therapy (TACE-combined treatment group), according to the different treatment modalities. All the clinicopathological and survival data were analyzed. ResultsThe median follow-up of the 139 cases was 23 months (range 1-40 months). The 1-, 2-, and 3-year overall survival (OS) rates of the TACE group were 79.2%, 43.8% and 24.0%, respectively; while 86.0%, 76.7% and 58.1%, respectively, for the combined treatment group (χ² = 8.691, P = 0.003). The univariate analysis showed that the patients’ gender, age and cirrhosis were not significantly correlated with prognosis of the patients (P all > 0.05), but multimodality therapy, Child’s grading, ECOG scores, levels of AFP, tumor sizes, tumor numbers, portal vein tumor thrombus and BCLC grade were significantly related to overall survival. Moreover, the Cox multivariant survival analysis revealed that tumor size, portal vein tumor thrombus, levels of AFP and BCLC grade were independent prognostic indicators to HCV-HCC, with significant differences (P all < 0.05). ConclusionsMultimodality therapy is a safe and effective treatment method for hepatitis C virus-related hepatocellular carcinoma.