多发性肝细胞癌113例患者临床治疗的回顾性分析

摘要

Objective To review and analyze the clinicopathological features,the treatment and the prognosis of patients with multiple hepatocellular carcinoma.Methods The data of 113 patients with multiple hepatocellular carcinoma treated between Jan.to Dec.2009 at the Tianjin Medical University Cancer Hospital were reviewed.The overall survival and the independent risk factors related to survival of these patients were statistically analyzed.Results The 1-,2-,and 3-year overall survival rates of these patients were 36％,19％,and 11％ respectively,and the median survival was 11.6 months.The 1-,2-,and 3-year survival rates of the radical hepatic resection group were 64％,45％,and 27％,which were significantly higher than those of the TACE group (33％,13％,and 7％ respectively),and also those of the supportive treatment group (0％,0％,and 0％ respectively).Univariate analysis showed that age,tumor location,hepatitis background,tumor size,total tumor number,treatment and ALT were prognostic factors of longterm survival for patients with multiple HCC.Multivariate analysis revealed that age,hepatitis,tumor size,tumor number,and type of treatment were independent risk factors related to survival.Conclusions Patients with multiple hepatocellular carcinoma who were in class B or C of the BCLC classification benefited from R0 hepatic resection,if their liver function could tolerate the operation.Age,hepatitis,tumor size,tumor number,treatment were independent risk factors of survival.%目的 分析多发性肝细胞癌(HCCs)的临床病理特征、治疗选择和预后.方法 回顾性分析2009年1月至12月天津医科大学附属肿瘤医院收治的1 13例多发性肝细胞癌患者的临床资料,比较根治性肝切除术、经导管肝动脉化疗栓塞术(TACE)和支持治疗患者的预后差异.结果 113例多发性肝细胞癌患者的1、2、3年生存率分别为36％、19％、11％,中位生存时间11.6个月.根治性肝切除术组(n=22)患者1、2、3年生存率分别为64％、45％、27％;TACE组患者(n =83)33％、13％、7％;支持治疗组患者(n=8)均于1年内死亡,三组之间差异有统计学意义.单因素分析显示年龄、肿瘤分布、肿瘤个数、最大肿瘤直径、肝炎背景、治疗方式、ALT为影响多发性肝细胞癌患者预后的危险因素.多因素分析显示年龄、治疗方式、肿瘤个数、最大肿瘤直径、肝炎背景为影响预后的独立因素.结论 对于BCLC分期为B级或C级的多发性肝细胞癌患者,在肝功能可以耐受且手术可以达到R0切除的情况下,肝切除术仍不失为其最有效的治疗方法.年龄、治疗方式、肿瘤个数、最大肿瘤直径、肝炎背景是影响多发性肝细胞癌患者预后的独立危险因素.