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[经导管动脉化疗栓塞联合射频消融治疗原发性肝癌的预后因素及模型]

[Prognostic factors and model of primary liver cancer treated with transcatheter arterial chemoembolization combined with radiofrequency ablation].

作者信息

Li J, Zhu W L, Kang X X, Zheng L, Guo C Y, Yu P, Xiao J C

机构信息

Department of Minimally-invasive Interventional Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Province Cancer Hospital, Zhengzhou 450008, China.

Department of Medical Oncology, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning 530011, China.

出版信息

Zhonghua Zhong Liu Za Zhi. 2017 Oct 23;39(10):787-791. doi: 10.3760/cma.j.issn.0253-3766.2017.10.013.

Abstract

To investigate the prognostic factors of primary liver cancer treated with transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA), and then to establish a prognostic model. Clinicopathological and follow-up data of 145 patients who underwent TACE combined with RFA from January 2010 to December 2012 were retrospectively analyzed. Univariate and multivariate survival analyses were performed using the Cox proportional hazards model, and the prognostic model was established. The 1, 2, and 3-year survival rates were 92.6%, 81.4% and 66.2%, respectively. The 3-year recurrence and metastasis rate was 64.8%.Multivariate analysis showed that female cases and higher serum albumin levels were the protective factors for the 3-year overall and relapse-free survival of patients(<0.05 for all). High levels of alpha-fetoprotein (AFP), alanine aminotransferase (ALT), total bilirubin (TBIL), portal vein thrombosis and higher Child Pugh stages were the independent risk factors for the 3-year overall survival(<0.05 for all). High levels of AFP, TBIL, portal vein thrombosis and advanced stages of BCLC staging (B and C) were the independent risk factors for tumor recurrence and metastasis(<0.05 for all). The predictive model established based on the multivariate analysis showed good sensitivity and specificity. The area under ROC curve were higher than 0.90. The prognosis of liver cancer patients treated with TACE combined with RFA is affected by various clinicopathological factors. The systematic evaluation of the relevant factors before treatment may help to select proper patients and improve prognosis.

摘要

探讨经动脉化疗栓塞术(TACE)联合射频消融术(RFA)治疗原发性肝癌的预后因素,并建立预后模型。回顾性分析2010年1月至2012年12月期间接受TACE联合RFA治疗的145例患者的临床病理及随访资料。采用Cox比例风险模型进行单因素和多因素生存分析,并建立预后模型。1年、2年和3年生存率分别为92.6%、81.4%和66.2%。3年复发转移率为64.8%。多因素分析显示,女性病例和较高的血清白蛋白水平是患者3年总生存和无复发生存的保护因素(均P<0.05)。甲胎蛋白(AFP)、丙氨酸转氨酶(ALT)、总胆红素(TBIL)水平高、门静脉血栓形成及较高的Child Pugh分期是3年总生存的独立危险因素(均P<0.05)。AFP、TBIL水平高、门静脉血栓形成及BCLC分期晚期(B期和C期)是肿瘤复发转移的独立危险因素(均P<0.05)。基于多因素分析建立的预测模型具有良好的敏感性和特异性。ROC曲线下面积均高于0.90。TACE联合RFA治疗的肝癌患者预后受多种临床病理因素影响。治疗前对相关因素进行系统评估有助于选择合适的患者并改善预后。

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