摘要
目的探讨氩氦冷冻消融治疗进展期肝细胞癌（HCC）的临床疗效，并分析影响其疗效的预测因素。方法对2005-2008年在我院治疗的190例乙型肝炎相关进展期HCC患者采用临床队列方法，分为氩氦冷冻消融治疗组（147例）和对照组（43例），比较两组中位生存期（OS）和肿瘤进展时间（TTP），评价年龄、性别、门静脉癌栓位置、HBeAg状态、肿瘤组织分化程度、Child—Pugh分级、终末期肝病模型（MELD）评分、进展期肝癌预测系统（ALCPS）评分及东部肿瘤协作组体能状态（ECOGPS）评分对冷冻消融疗效预测的影响。组间率的比较用x2检验；生存分析用Kaplan-Meier法，生存率的比较用Log—rank分析；多因素对生存期的影响用Cox回归模型进行分析。结果冷冻消融治疗组和对照组患者中位OS分别为7．5（4．2～14．6）个月和3．2（1．2～8．6）个月，中位TrP分别为3．5（2．5～4．5）个月和1．5（1．0～3．5）个月，差异均有统计学意义（P值均〈0．05）。肿瘤细胞高分化、Child—pughA级及MELD评分、ALCPS评分和ECOGPS评分好的进展期HCC患者中位OS和TTP明显长于肿瘤细胞低分化、Child-pughB级及各系统评分差的患者（P值均〈0．05）。对进展期HCC患者的OS具有独立预测作用的因素为ECOGPS（Jp〈0．05，95％可信区间为1．074～2．143）和ALCPS（P〈0．05，95％可信区间为1．005～2．121）。结论冷冻消融治疗进展期HCC能够延长患者中位OS和TTP；ECOGPS和ALCPS评分系统是进展期HCC患者OS的重要预测因素。
Objectives Investigate the clinical efficacy of cryotherapy ablation treatment for advanced hepatocellular carcinoma, analyse the predictive factors of cryotherapy ablation treatment. Methods There were 190 cases of hepatitis B-related HCC patients with advanced HCC from 2005 to 2008 in our hospital. By using clinical cohort method, they included cryoablation group （147 cases） and control group （43 cases）, The median survival time and time to disease progression were compared. Evaluate clinical significance of age, gender, location of portal vein tumor thrombus, HBeAg, tumor histological grade, Child-Pugh classification, end-stage liver disease （MELD） score, advanced liver cancer prediction system （ALCPS） score and the Eastern Cooperative Oncology Group performance status （ECOG PS） score for predicting the efficacy of cryoablation. Group rates were compared with the x 2 test, survival analysis by using Kaplan-Meier method,survival rates were compared by Log-rank analysis; multiple factor survival analysis by using Cox regression model. Results Median survival time ofcryoablation goup and Control group was 7.5 （4.2 to 14.6） months and 3.2 （1.2 to 8.6） months, median TTP was 3.5 （2.5 to 4.5） months and 1.5 （1.0 to 3.5 months）, the differences were statistically significant （P 〈 0.05 ）. Median OS and TTP of advanced HCC patients who had Well-differentiated tumor, Child-pugh A-class and low score of MELD score, ALCPS score, ECOG PS score were significantly longer than the poorly differentiate, Child-Pugh B-class and the high those scores （P〈 0.05）. ECOG PS （P〈0.05, 95% CI 1.074 - 2.143） and ALCPS （P〈0.05, 95% CI 1.005 - 2.121） were independent predictors for OS of advanced HCC. Conclusions Cryoablation treatment can prolong median OS and TTP of advanced HCC; ECOG PS andALCPS are important predictors for survival time of advanced HCC.
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2011年第10期759-763,共5页
Chinese Journal of Hepatology
关键词
癌
肝细胞
冷冻外科手术
生存率
进展时间
Carcinoma, hepatocellular Cryosurgery Survival rate Time to progression
