摘要
目的研究初始不可切除肝癌转化治疗的影响因素,为个体化治疗策略提供循证医学证据。方法本研究采用回顾性病例对照研究方法,纳入宁波大学附属李惠利医院2018年1月至2022年8月期间初始不可切除、经过全身治疗且转化成功的39例肝癌患者,并将同期转化治疗失败的103例纳入对照组。采用Logistic回归分析各临床特征对不可切除肝癌转化治疗结局的影响。结果本研究共纳入142例初始不可切除肝癌患者,39例(27.4%)转化治疗成功,其中33例患者接受了手术治疗,103例转化失败。中位随访时间23个月,转化治疗成功的患者其总生存时间明显延长(47个月比18个月,P<0.001)。单因素分析发现:应用三联疗法(P=0.039)、肿瘤单叶分布(P=0.029)、血管未受肿瘤侵犯(P=0.001)、C反应蛋白≤8 mg/L(P=0.016)、血小板>125×109/L(P=0.043)、白蛋白>40 g/L(P=0.001)以及国际标准化比值<1.15(P=0.033)是转化治疗成功的保护因素。多因素分析结果提示:应用三联疗法(HR=0.256,95%CI:0.071~0.930,P=0.038)、血管未受肿瘤侵犯(HR=0.238,95%CI:0.093~0.609,P=0.003)和白蛋白>40 g/L(HR=0.384,95%CI:0.155~0.950,P=0.038)是初始不可切除肝癌患者转化治疗成功的独立保护因素。结论血管有无侵犯、白蛋白水平是影响不可切除肝癌转化治疗的关键性因素;若患者一般状况良好,应积极使用三联疗法进行转化治疗。
Objective To investigate the influencing factors of outcome of conversion therapy of initially unresectable hepatocellular cancer(iuHCC)to provide evidence for individualized treatment strategies.Methods This study was a retrospective case-control study that involved 142 patients with iuHCC,including 39 patients with iuHCC who underwent systemic treatment and achieved conversion success at the Affiliated Li Huili Hospital of Ningbo University from January 2018 to August 2022,and 103 patients with failed conversion therapy during the same period as controls.Logistic regression analysis was used to analyze the impact of clinical characteristics on the outcome of conversion therapy for unresectable liver cancer.Results A total of 142 patients with iuHCC were included in this study,of which 39(27.4%)achieved conversion success,including 33 cases who underwent surgery,and 103 achieved conversion failure.The median follow-up time was 23 months.The overall survival time of patients with successful conversion therapy was significantly prolonged(47 months vs 18 months,P<0.001).Single-factor logistic regression analysis showed that using triple therapy(P=0.039),tumor distribution in one lobe(P=0.029),blood vessels not invaded by the tumor(P=0.001),C-reactive protein≤8 mg/L(P=0.016),platelet count≥125×109/L(P=0.043),serum albumin≥40 g/L(P=0.001),and international normalized ratio(INR)≤1.15(P=0.033)were protective factors for conversion therapy success.The results of multivariate logistic regression analysis suggested that using triple therapy(hazard ratio[HR]=0.256,95%confidence interval[CI]:0.071~0.930,P=0.038),blood vessels not invaded by the tumor(HR=0.238,95%CI:0.093~0.609,P=0.003)and serum albumin>40 g/L(HR=0.384,95%CI:0.155~0.950,P=0.038)were independent protective factors for successful conversion therapy in patients with iuHCC.Conclusion Vascular invasion and serum albumin level are key factors affecting the outcome of conversion therapy of iuHCC.If the patient's general condition is good,triple therapy should be actively used for conversion therapy.
作者
陆知非
华永飞
姜哲康
高过
江寅
王高卿
Lu Zhifei;Jiang Zhekang;Hua Yongfei;Gao Guo;Jiang Yin;Wang Gaoqing(Department of Hepatic-biliarypancreatic Surgery,the Affiliated Lihuili Hospital of Ningbo University,Ningbo 315040,China)
出处
《中华临床医师杂志（电子版）》
CAS
2024年第3期268-274,共7页
Chinese Journal of Clinicians(Electronic Edition)
关键词
肝细胞癌
初始不可切除
转化治疗
综合治疗
Hepatocellular carcinoma
Initially unresectable
Conversion therapy
Combined therapy
