肝切除术与经动脉化疗栓塞术治疗孤立性巨大肝细胞癌的疗效比较
Efficacy of hepatic resection vs transarterial chemoembolization for solitary huge hepatocellular carcinoma.
作者信息
Zhu Shao-Liang, Zhong Jian-Hong, Ke Yang, Ma Liang, You Xue-Mei, Li Le-Qun
机构信息
Shao-Liang Zhu, Jian-Hong Zhong, Yang Ke, Liang Ma, Xue-Mei You, Le-Qun Li, Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
出版信息
World J Gastroenterol. 2015 Aug 28;21(32):9630-7. doi: 10.3748/wjg.v21.i32.9630.
AIM
To compare the efficacy of hepatic resection (HR) and transarterial chemoembolization (TACE) for patients with solitary huge (≥ 10 cm) hepatocellular carcinoma (HCC).
METHODS
Records were retrospectively analyzed of 247 patients with solitary huge HCC, comprising 180 treated by HR and 67 by TACE. Long-term overall survival (OS) was compared between the two groups using the Kaplan-Meier method, and independent predictors of survival were identified by multivariate analysis. These analyses were performed using all patients in both groups and/or 61 pairs of propensity score-matched patients from the two groups.
RESULTS
OS at 5 years was significantly higher in the HR group than the TACE group, across all patients (P = 0.002) and across propensity score-matched pairs (36.4% vs 18.2%, P = 0.039). The two groups showed similar postoperative mortality and morbidity. Multivariate analysis identified alpha-fetoprotein ≥ 400 ng/mL, presence of vascular invasion and TACE treatment as independent predictors of poor OS.
CONCLUSION
Our findings suggest that HR can be safe and more effective than TACE for patients with solitary huge HCC.
目的
比较肝切除术（HR）和经动脉化疗栓塞术（TACE）治疗孤立性巨大（≥10 cm）肝细胞癌（HCC）患者的疗效。
方法
回顾性分析247例孤立性巨大HCC患者的记录，其中180例行肝切除术，67例行经动脉化疗栓塞术。采用Kaplan-Meier法比较两组的长期总生存期（OS），并通过多因素分析确定生存的独立预测因素。这些分析在两组所有患者和/或两组61对倾向评分匹配患者中进行。
结果
在所有患者中（P = 0.002）以及倾向评分匹配对中（36.4%对18.2%，P = 0.039），肝切除组5年总生存期显著高于经动脉化疗栓塞组。两组术后死亡率和发病率相似。多因素分析确定甲胎蛋白≥400 ng/mL、血管侵犯的存在和经动脉化疗栓塞治疗是总生存期差的独立预测因素。
结论
我们的研究结果表明，对于孤立性巨大HCC患者，肝切除术可能比经动脉化疗栓塞术更安全、更有效。
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