TACE改善伴有肝外转移肝细胞癌患者预后

摘要

目的：探讨肝动脉化疗栓塞(TACE)对伴有肝外转移的肝细胞癌患者预后的影响.方法：回顾性分析本院2007年1月至2009年1月72例此类患者的临床资料,Kaplan-Meier法计算生存率,Log-rank检验和Cox回归模型分别进行预后单、多因素分析.结果：72例患者中Child A-B级63例,接受TACE或肝动脉灌注化疗(TACI),部分患者联合全身化疗(SC)或仅行保守治疗.最长随访时间35个月,死亡56例(88畅9%).患者1-,2年的总生存率分别为19畅5%,7畅4%.T1-2期(20例)行TACE/TACI+SC ,TACE/TACI ,SC和CM的患者中位生存时间分别为23,12,5,3个月,T3期(43例)患者对应数据为7,5,3,2个月.TACE/TACI单独使用或联合SC的治疗效果均显著优于CM(P<0畅05).Cox多因素分析发现高UICC/AJCC T分期,大血管侵犯,淋巴结或肺转移,未接受TACE/TACI治疗是影响患者预后的独立危险因素.结论：TACE/TACI能改善肝功能良好,伴肝外转移的HCC患者的预后,延长其生存时间.%Objective] To explore the influence of transarterial chemoembolization (TACE) in patients with extrahepatic meta-sitasis at initial diagnosis of hepatocellular carcinoma (HCC) .[Method] Seventy two patients with extrahepatic metasitasis at initial diagnosis of HCC in our department from January 2007 and January 2009 were enrolled for this retrospective analysis .Pa-tients were administrated TACE/TACI alone or plus systematic chemotherapy (SC) or only treated by conservative management (CM) .SPSS13 .0 software was used for statistical analysis .The Kaplan -Meier method was used to evaluate the survival rates .Log-rank test and Cox regression model were used to analysis the single and multi -factors for the prognosis .[Result] There were 63 patients with preserved liver function (Child A -B) .The longest time of follow -up was 35 months ,with a mortality of 88 .9% .The 1- and 2-year overall survival rates were 19 .5% and 7 .4% ,respectively .The median time of survival in patients (n=20) with T1-2 stage HCC was 23- ,12- ,5- and 3-month in TACE/TACI+SC ,TACE/TACI , SC and CM group respectively ,while the corresponding data for patients (n=43) with T3 stage HCC was 7- ,5- ,3- ,2-month respectively .TACE/TACI alone or plus SC improved prognosis significantly than CM (P<0 .05) .Multivariate Cox regression analysis showed that the high UICC/AJCC T stage ,macro-vascular invasive ,lymph node and lung metastasis and untreated by TACE/TACI were independent prognostic factors .[Conclusion]TACE/TACI can significantly improve the prog-nosis of metastatic HCC patients with conserved liver function .