肝癌多学科协作组诊疗的预后影响因素分析

摘要

目的 分析多学科协作组(MDT)诊疗中关键因素对肝癌MDT患者预后的影响.方法 将2015年1月1日至2015年12月31日进行MDT诊疗的132例HBsAg阳性的肝癌患者纳入回顾性研究,获取其随访数据(至2017年12月31日).按巴塞罗那分期、MDT意见依从性及是否多学科联合治疗等变量进行分组,对生存期(OS)及肿瘤至进展时间(TTP)进行统计分析.结果 依从MDT意见组的生存情况优于非依从组,二者生存曲线差异有统计学意义(x2=4.062,P＜0.05),前者的1、2年生存率为72.0％、60.9％,后者为64.3％、40.3％.联合治疗组的生存情况优于非联合治疗组,二者生存曲线差异有统计学意义(x2=9.502,P＜0.05),且是生存期的独立影响因素(HR=0.451,95％可信区间为0.210 ～ 0.968),前者的1、2年生存率为82.2％、75.4％,后者为63.1％、44.6％.依从且联合组的中位生存期为29.4个月,未依从且未联合组为17.0个月,差异有统计学意义(x2=13.336,P＜0.001).联合治疗组的中位肿瘤至进展时间为15.7个月,非联合治疗组为10.1个月,差异有统计学意义(x2=7.263,P＜0.05).结论 提高MDT意见依从性及实施多学科联合治疗可能有助于改善肝癌MDT患者预后.%Objective To analyze the prognostic factors on multidisciplinary team patients for diagnosis,and treatment of hepatocellular carcinoma.Methods This retrospective study enrolled 132 HBsAg positive patients with HCC.MDT diagnostic approach was conducted at our hospital between 1 January 2015 and 31 December 2015,and all patients were followed up to 31 December 2017.Groups were arranged according to variables such as Barcelona stage,MDT compliance,and multidisciplinary combination therapy.TTP and OS were statistically analyzed.Results The survival of the MDT compliance group was better than the non-compliance group.The difference in survival curves was statistically significant (x 2 =4.062,P ＜ 0.05).The 1-and 2-year survival rates of the former group were 72.0％,60.9％,and the latter was 64.3％,40.3％.The survival of the combined treatment group was better than the non-combination group.The survival curves of the two groups were statistically significant (x2 =9.502,P ＜ 0.05),and they were independent influencing factors of survival (HR =0.451,95％ CI,0.210-0.968).The 1-and 2-year survival rates of the former group were 82.2％ and 75.4％,and the latter was 63.1％ and 44.6％.The median survival time of the follow-up group was 29.4 months,and the non-compliance and the uncombined group were 17.0 months.The difference was statistically significant (x2 =13.336,P ＜ 0.001).The median tumor progression time was 15.7 months in the combination group and 10.1 months in the non-compliance group (x 2 =7.263,P ＜ 0.05).Conclusion An advanced MDT compliance with implementation of multidisciplinary combination therapy may help to improve the prognosis of MDT patients with liver cancer.