摘要
目的探讨不同治疗方法对非手术肝细胞癌患者预后的影响。方法回顾性分析我院肿瘤中心2003年7月至2007年12月收治的358例肝癌患者,建立病例资料数据库,应用Kaplan-Meier方法计算生存期,对相关因素采用Log-rank检验进行生存率的单因素分析以及Cox风险比例模型进行多因素分析,筛选出独立预后因素。结果 358例患者中位总生存时间(OS)为13个月。1、2、3年生存率分别为55.7%、23.9%和11.0%。UICC分期Ⅰ、Ⅱ、ⅢA、ⅢB和Ⅳ期患者中位OS分别为26、24、13、9和11个月。病灶数目、肿瘤大小、临床分期、Child分级、AFP水平、门脉癌栓和体质评分均为影响患者的预后因素,进一步多因素Cox风险比例模型分析显示,临床分期、Child分级、肿瘤体积、门脉癌栓为独立的预后因素。27例单独TACE治疗患者的中位OS为12个月,184例单独立体定向放疗患者的中位OS为11个月,TACE加立体定向放射治疗37例患者的中位OS为17个月,18例重组人p53腺病毒注射液联合放化疗患者的中位OS为22个月。结论肝癌综合治疗的疗效显著高于单一治疗,可以根据临床分期、Child分级、肿瘤体积和体质评分选择合适的治疗方法 ,尤其是多种治疗方法的序贯和同步联合治疗。
Objective To explore the prognostic factors in patients with hepatocellular carcinoma and the possible influence on them by using combination therapy.Methods Three hundreds and fifty-eight cases of hepatocellular carcinoma treated in our hospital from July 2003 to December 2007 were retrospectively analyzed.The survival rates were calculated by the Kaplan-Meier analysis and carried on single factor analysis to some related factors.The Kaplan-Meier method with difference in survival estimated by Log-rank test was also used in the calculating of survival rates,and multivariate analysis of these variables was performed by Cox proportional hazard model.With the above approaches,we got the independent significant prognostic factors.Results The median survival time for the 358 patients was 13 months.The 1-,2-,3-year survival rates were 55.7%,23.9% and 11.0%,respectively.And the median survival time for UICC staging of Ⅰ,Ⅱ,ⅢA,ⅢB and Ⅳ were 26 months,24 months,13 months,9 months and 11 months,respectively.Tumor number,Child grade,UICC staging,tumor volume,AFP level,portal vein embolus and physical status scores were the prognostic factors.While the multi-factor analysis with Cox proportional hazard model showed the Child grade,UICC staging,tumor volume and portal vein embolus were independent prognostic factors of patients.The median survival time for 27 cases treated with TACE only,184 cases treated by SRT,18 cases by rAd-p53 combined radiotherapy and chemotherapy,37 cases by TACE and SRT were 12 months,11 months,22 months and 17 months,respectively.Conclusion The combination therapy effects of hepatocellular carcinoma patients were significantly higher than the single approach.In clinical practice,the proper regimen should be taken according to the tumor staging,Child grade,and physical status scores,especially the simultaneous or sequential combined therapies should be taken.
出处
《临床肿瘤学杂志》
CAS
2010年第5期418-424,共7页
Chinese Clinical Oncology
关键词
肝细胞癌
综合治疗
预后因素
Hepatocellular carcinoma
Combination therapy
Prognosis factor
