汪艷，陳樂(lè)

(黃岡市中心醫(yī)院感染科，湖北 黃岡 438000)

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肝動(dòng)脈化療栓塞治療乙型肝炎相關(guān)性肝癌的預(yù)后影響

汪艷，陳樂(lè)

(黃岡市中心醫(yī)院感染科，湖北 黃岡 438000)

目的 探討肝動(dòng)脈化療栓塞治療乙型肝炎相關(guān)性肝癌的預(yù)后影響因素。方法 對(duì)行肝動(dòng)脈化療栓塞治療的150例患者臨床資料進(jìn)行回顧性分析，觀察肝動(dòng)脈化療栓塞治療3年后患者生存率，并對(duì)肝動(dòng)脈化療栓塞治療乙型肝炎相關(guān)性肝癌的預(yù)后影響因素采用單因素分析及Logistic多因素分析。 結(jié)果 (1)150例乙型肝炎相關(guān)性肝癌患者經(jīng)肝動(dòng)脈化療栓塞治療3年后，存活64例，死亡86例， 3年生存率為42.67%，死亡率為57.33%。(2)單因素分析得出：假包膜形成、癌灶數(shù)目多、門(mén)脈癌栓、腫瘤直徑大、胸腔轉(zhuǎn)移、腹腔轉(zhuǎn)移均為肝動(dòng)脈化療栓塞治療乙型肝炎相關(guān)性肝癌的危險(xiǎn)因素為肝動(dòng)脈化療栓塞治療乙型肝炎相關(guān)性肝癌的保護(hù)因素，均差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。(3)經(jīng)Logistic多因素回歸分析得出：假包膜形成、癌灶多發(fā)、門(mén)脈癌栓、腫瘤直徑≥5 cm、胸腔轉(zhuǎn)移、腹腔轉(zhuǎn)移均為肝動(dòng)脈化療栓塞治療乙型肝炎相關(guān)性肝癌的危險(xiǎn)因素。結(jié)論 假包膜形成、癌灶多發(fā)、門(mén)脈癌栓、腫瘤直徑≥5 cm、胸腔轉(zhuǎn)移、腹腔轉(zhuǎn)移均為肝動(dòng)脈化療栓塞治療乙型肝炎相關(guān)性肝癌的危險(xiǎn)因素。

乙型肝炎相關(guān)性肝癌；肝動(dòng)脈化療栓塞治療；危險(xiǎn)因素

乙型肝炎相關(guān)性肝癌病情進(jìn)展迅速，但起病具有隱匿性，因此一旦確診絕大多數(shù)患者已出現(xiàn)胸腹部等遠(yuǎn)處轉(zhuǎn)移情況，從而使得無(wú)法手術(shù)治療，失去最佳治療時(shí)機(jī)，預(yù)后差[1]。目前，乙型肝炎相關(guān)性肝癌的主要治療方法為肝動(dòng)脈化療栓塞，已被臨床廣泛應(yīng)用[2]。近年來(lái)，如何更好的治療乙型肝炎相關(guān)性肝癌已逐漸成為臨床醫(yī)生研究的熱點(diǎn)[3]。為此筆者回顧性分析行肝動(dòng)脈化療栓塞治療的150例患者臨床資料，現(xiàn)將結(jié)果報(bào)告如下。

1 資料與方法

1.1 臨床資料 回顧性分析2010年2月至2012年10月在黃岡市中心醫(yī)院進(jìn)行肝動(dòng)脈化療栓塞治療的150例患者臨床資料，其中男性83例，女性67例；年齡16～81歲，平均(46.97±11.22)歲；其中癌灶單發(fā)者99例，癌灶多發(fā)者51例；假包膜形成者54例，無(wú)假包膜形成者96例；存在門(mén)脈癌栓者39例，未見(jiàn)門(mén)脈癌栓者111例。本研究獲得黃岡市中心醫(yī)院倫理委員會(huì)批準(zhǔn)，患者或近親屬簽署了知情同意書(shū)。

1.2 方法

1.2.1 肝動(dòng)脈化療栓塞治療 選擇Seldinger 技術(shù)進(jìn)行肝腸系膜上動(dòng)脈與總動(dòng)脈常規(guī)造影術(shù)，觀察門(mén)靜脈充盈狀態(tài)及肝臟內(nèi)部腫瘤供血狀況。采用夾心式進(jìn)行局部化療栓塞，注入羥基喜樹(shù)堿、氟脲嘧啶、絲裂霉素、表阿霉素及順鉑等藥物。藥物劑量根據(jù)肝功能情況、腫瘤分布及腫瘤大小而定。

1.2.2 隨訪 全部患者均建立詳細(xì)的資料檔案，出院后通過(guò)電話、郵件、登門(mén)等方式定時(shí)進(jìn)行隨訪。

1.3 觀察指標(biāo) (1)觀察肝動(dòng)脈化療栓塞治療3年后患者生存率；(2)單因素分析肝動(dòng)脈化療栓塞治療乙型肝炎相關(guān)性肝癌的預(yù)后相關(guān)因素，其中包括年齡、性別、假包膜形成、癌灶數(shù)目、門(mén)脈癌栓、腫瘤大小、胸腔轉(zhuǎn)移、腹腔轉(zhuǎn)移及化療次數(shù)；(3)經(jīng)Logistic多因素回歸分析肝動(dòng)脈化療栓塞治療乙型肝炎相關(guān)性肝癌的預(yù)后相關(guān)因素。

2 結(jié)果

2.1 肝動(dòng)脈化療栓塞治療3年后患者生存率 150例乙型肝炎相關(guān)性肝癌患者經(jīng)肝動(dòng)脈化療栓塞治療3年后，存活64例，死亡86例， 3年生存率為42.67%，死亡率為57.33%。

2.2 單因素分析肝動(dòng)脈化療栓塞治療乙型肝炎相關(guān)性肝癌的預(yù)后相關(guān)因素 單因素分析得出：假包膜形成、癌灶數(shù)目多、門(mén)脈癌栓、腫瘤直徑大、胸腔轉(zhuǎn)移、腹腔轉(zhuǎn)移均為肝動(dòng)脈化療栓塞治療乙型肝炎相關(guān)性肝癌的危險(xiǎn)因素(P<0.05)，見(jiàn)表1。

表1 單因素分析肝動(dòng)脈化療栓塞治療乙型肝炎相關(guān)性肝癌的預(yù)后相關(guān)因素/例

2.3 Logistic多因素分析肝動(dòng)脈化療栓塞治療乙型肝炎相關(guān)性肝癌的預(yù)后相關(guān)因素 經(jīng)Logistic多因素回歸分析得出：假包膜形成、癌灶多發(fā)、門(mén)脈癌栓、腫瘤直徑≥5 cm、胸腔轉(zhuǎn)移、腹腔轉(zhuǎn)移均為肝動(dòng)脈化療栓塞治療乙型肝炎相關(guān)性肝癌的危險(xiǎn)因素，見(jiàn)表2。

表2 Logistic多因素分析肝動(dòng)脈化療栓塞治療乙型肝炎相關(guān)性肝癌的預(yù)后相關(guān)因素

3 討論

原發(fā)性肝癌屬于我國(guó)臨床上常見(jiàn)的惡性腫瘤，該病進(jìn)展迅速，起病隱匿，一旦確診絕大多數(shù)患者已出現(xiàn)遠(yuǎn)處轉(zhuǎn)移，從而失去手術(shù)最佳治療時(shí)機(jī)[4-9]。目前，作為不能進(jìn)行手術(shù)切除以及手術(shù)復(fù)發(fā)者，肝動(dòng)脈化療栓塞治療能否有效改善乙型肝炎相關(guān)性肝癌患者的預(yù)后仍存在爭(zhēng)議[10]。有相關(guān)研究[11-13]顯示，進(jìn)行肝動(dòng)脈化療栓塞治療的乙型肝炎相關(guān)性肝癌患者的中位生存時(shí)間明顯高于保守治療患者。但亦有相關(guān)研究[14]顯示，雖然肝動(dòng)脈化療栓塞治療能夠抑制腫瘤生長(zhǎng)，但對(duì)于提高患者生存率未見(jiàn)顯著效果。本研究結(jié)果顯示，150例乙型肝炎相關(guān)性肝癌患者經(jīng)肝動(dòng)脈化療栓塞治療3年后，存活64例，死亡86例， 3年生存率為42.67%，死亡率為57.33%。

經(jīng)本研究結(jié)果顯示并總結(jié)肝動(dòng)脈化療栓塞治療乙型肝炎相關(guān)性肝癌的預(yù)后影響因素，具體如下：(1)假包膜形成：假包膜形成者的3年生存率為24.07%，顯著低于未見(jiàn)假包膜形成者的53.13%，差異有統(tǒng)計(jì)學(xué)意義(P<0.05)，此結(jié)果表明，存在假包膜不利于肝動(dòng)脈化療栓塞治療乙型肝炎相關(guān)性肝癌的預(yù)后；(2)癌灶數(shù)目：通過(guò)對(duì)比癌灶單發(fā)與多發(fā)情況得出，癌灶多發(fā)者3年生存率為21.57%，顯著低于癌灶單發(fā)者的53.54%，比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)，癌灶多發(fā)嚴(yán)重影響乙型肝炎相關(guān)性肝癌的預(yù)后；(3)腫瘤直徑：腫瘤越大，肝動(dòng)脈化療栓塞治療的預(yù)后越差，乙型肝炎相關(guān)性肝癌的3年生存率越低；(4)胸腹腔轉(zhuǎn)移：若出現(xiàn)胸腔或腹腔轉(zhuǎn)移，腫瘤則更難控制，嚴(yán)重治療預(yù)后，生存率顯著降低。

綜上所述，假包膜形成、癌灶多發(fā)、門(mén)脈癌栓、腫瘤直徑≥5 cm、胸腔轉(zhuǎn)移、腹腔轉(zhuǎn)移均為肝動(dòng)脈化療栓塞治療乙型肝炎相關(guān)性肝癌的危險(xiǎn)因素。

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Prognostic impact of transcatheter arterial chemoembolization in the treatment of hepatitis B associated hepatocellular carcinoma

WANG Yan,CHEN Le

(DepartmentofInfectiousDiseases,HuanggangCentralHospital,Huanggang,Hubei438000，China)

Objective To investigate the prognostic factors of hepatic artery chemoembolization in the treatment of hepatitis B associated hepatocellular carcinoma.Methods Clinical data of 150 cases undergoing hepatic artery chemotherapy embolization were retrospectively analyzed.Three-year survival rate of the patients was observed,and prognostic influence factors were analyzed using single factor analysis and Logistic multivariate regression analysis.Results Three years after the treatment,of 150 cases of HBV related hepatocellular carcinoma patients,64(42.67%)cases survived,and 86(57.33%)cases died.The single factor analysis showed that pseudocapsule formation,tumor number,tumor thrombus in the portal vein,diameter of tumor,pleural and peritoneal metastases were risk factors of hepatic artery chemoembolization in the treatment of hepatitis B virus associated hepatocellular carcinoma.The differences were statistically significant(P<0.05).The Logistic multivariate regression analysis showed that pseudocapsule formation,cancer lesions,portal vein tumor thrombus,tumor diameter greater than 5 cm,pleural and peritoneal metastases were risk factors of hepatic arterial chemoembolization in the treatment of hepatitis B virus associated hepatocellular carcinoma.Conclusions Formation of pseudocapsule,multiple tumor,portal vein tumor thrombus,tumor diameter greater than or equal to 5 cm,pleural metastasis,and peritoneal metastasis are risk factors of transcatheter arterial chemoembolization in the treatment of hepatitis B virus related hepatocellular carcinoma(HCC).

Hepatitis B related hepatocellular carcinoma;Transcatheter arterial chemoembolization;Risk factor

10.3969/j.issn.1009-6469.2016.11.046

2016-04-12，

2016-08-23)