欢迎光临《中华消化外科杂志》官方网站
欢迎您, 游客! 登录 | 注册
首页 » 过刊浏览 » 杂志期刊
《中华消化外科杂志》2018年10月第17卷第10期论著

肝切除术与射频消融术治疗单发肿瘤直径≤5 cm肝细胞癌合并门静脉高压症患者的倾向评分匹配疗效分析

阅读全文:
收藏:【点击:63】【下载:18】
引用本文:
邹浩,吴力群.肝切除术与射频消融术治疗单发肿瘤直径≤5 cm肝细胞癌合并门静脉高压症患者的倾向评分匹配疗效分析[J].中华消化外科杂志,2018,17(10):1018-1023.DOI:10.3760/cma.j.issn.1673-9752.2018.10.010.
【摘要】

目的:比较肝切除术与射频消融术(RFA)治疗单发肿瘤直径≤5 cm肝细胞癌合并门静脉高压症(PHT)的临床疗效。
方法:采用倾向评分匹配及回顾性病例对照研究方法。收集2011年1月至2016年7月青岛大学附属医院收治的154例单发肿瘤直径≤5 cm 肝细胞癌合并PHT患者的临床病理资料。154例患者中,61例行R0肝切除术,93例行RFA。观察指标:(1)倾向评分匹配情况及匹配后两组患者一般资料比较:采用倾向评分匹配法对两类患者资料进行匹配。将匹配后行肝切除术患者设为肝切除术组,行RFA患者设为RFA组。(2)随访和生存情况。采用门诊和电话方式进行随访。患者术后1个月行肝脏CT增强检查或MRI增强检查,术后3个月内每个月复查肝功能、甲胎蛋白水平、B超、肺部CT, 术后3个月至术后2年每3个月复查1次,2年后每6个月复查1次。了解患者无瘤生存情况和总体生存情况。随访时间截至2018年7月31日或死亡。偏态分布的计量资料以M(范围)表示。计数资料比较采用x2检验。采用Logistic回归模型进行倾向评分匹配。采用Kaplan-Meier法绘制生存曲线并计算生存率,采用Log-rank检验进行生存分析。
结果:(1)倾向评分匹配情况及匹配后两组患者一般资料比较:154例患者中118例(肝切除术组和RFA组各59例)配对成功。两组患者肿瘤直径和术前白蛋白水平倾向评分匹配前差异有统计学意义(x2=11.050,6.687,P<0.05),经倾向评分匹配后差异无统计学意义(x2=2.366,2.484,P>0.05)。(2)随访和生存情况:匹配前154例患者均获得术后随访,随访时间为4.5~91.4个月,中位随访时间为44.4个月。行肝切除术患者术后1、2、3、5年无瘤生存率分别为88.1%、79.5%、64.1%、40.3%,行RFA患者分别为84.9%、68.6%、52.8%、43.4%,两者无瘤生存情况比较,差异无统计学意义 (x2=0.997,P>0.05)。行肝切除术患者术后1、2、3、5年总体生存率分别为95.1%、88.5%、85.0%、70.1%,行RFA患者分别为100.0%、95.7%、85.6%、73.7%,两者总体生存情况比较,差异无统计学意义(x2=0.053,P>0.05)。匹配后118例患者均获得术后随访,随访时间为4.5~91.4个月,中位随访时间为49.4个月。肝切除术组患者术后1、2、3、5年无瘤生存率分别为89.4%、82.3%、66.4%、41.7%,RFA组患者分别为83.1%、64.2%、47.4%、38.5%,两组无瘤生存情况比较,差异无统计学意义(x2=2.612,P>0.05)。肝切除术组患者术后1、2、3、5年总体生存率分别为94.9%、89.8%、86.1%、70.8%,RFA组患者分别为100.0%、91.5%、79.4%、67.6%,两组总体生存情况比较,差异无统计学意义(x2=0.383,P>0.05)。
结论:肝切除术与RFA治疗单发肿瘤直径≤5 cm 肝细胞癌合并PHT临床疗效相当,均为可靠的根治性治疗手段。

【Abstract】

Objective:To compare the clinical efficacy of hepatectomy and radiofrequency ablation (RFA) for patients with solitary hepatocellular carcinoma (HCC) less than or equal to 5 cm (≤5 cm) and portal hypertension (PHT).
Methods:The propensity score matching and retrospective casecontrol study was conducted. The clinicopathological data of 154 patients with solitary HCC ≤ 5 cm and PHT who were admitted to the Qingdao University between January 2011 and July 2016 were collected. Of 154 patients, 61 and 93 underwent R0 hepatectomy and RFA, respectively. Observation indicators: (1) the propensity score matching conditions and comparison of general data between groups after the propensity score matching: patients′ data were matched by the propensity score matching, patients undergoing hepatectomy and RFA were respectively allocated into the hepatectomy group and RFA group; (2) followup and survival. Followup using outpatient examination and telephone interview was performed to detect postoperative tumorfree and overall survival up to July 31, 2018. Patients received enhanced scans of computed tomography (CT) or magnetic resonance imaging (MRI) in 1 month postoperatively, and then reexaminations of liver function, level of alphafetoprotein (AFP), B ultrasound and pulmonary CT within 3 months postoperatively, once every 3 months from 3 months postoperatively to 2 years and once every 6 months after 2 years postoperatively. Measurement data with skewed distribution were described as M (range). Comparisons of count data were analyzed using chisquare test. The Logistic regression model was used for the propensity score matching. The survival curve and rate were respectively drawn and calculated by the Kaplan-Meier method, and Log-rank test was used for survival analysis.
Results:(1) The propensity score matching conditions and comparison of general data between groups after the propensity score matching: 118 of 154 patients had successful matching, including 59 in each group. There were statistically significant differences in the tumor diameter and level of preoperative albumin (Alb) before the propensity score matching between groups (x2=11.050, 6.687, P<0.05), and no statistically significant difference after the propensity score matching between groups (x2=2.366, 2.484, P>0.05). (2) Followup and survival: all the 154 patients were followed up for 4.5-91.4 months before the propensity score matching, with a median time of 44.4 months. The postoperative 1, 2, 3 and 5year tumorfree survival rates were respectively 88.1%, 79.5%, 64.1%, 40.3% in patients of hepatectomy group and 84.9%, 68.6%, 52.8%, 43.4% in patients of RFA group, with no statistically significant difference in the tumorfree survival between groups (x2=0.997, P>0.05). The postoperative 1, 2, 3 and 5year overall survival rates were respectively 95.1%, 88.5%, 85.0%, 70.1% in patients of hepatectomy group and 100.0%, 95.7%, 85.6%, 73.7% in patients of RFA group, with no statistically significant difference in the overall survival between groups (x2=0.053, P>0.05). One hundred and eighteen patients were followed up for 4.5-91.4 months after the propensity score matching, with a median time of 49.4 months. The postoperative 1, 2, 3 and 5year tumorfree survival rates were respectively 89.4%, 82.3%, 66.4%, 41.7% in patients of hepatectomy group and 83.1%, 64.2%, 47.4%, 38.5% in patients of RFA group, with no statistically significant difference in the tumorfree survival between groups (x2=2.612, P>0.05). The postoperative 1, 2, 3 and 5year overall survival rates were respectively 94.9%, 89.8%, 86.1%, 70.8% in patients of hepatectomy group and 100.0%, 91.5%, 79.4%, 67.6% in patients of RFA group, with no statistically significant difference in the overall survival between groups (x2=0.383, P>0.05).
Conclusion:The both hepatectomy and RFA are reliable radical treatments for solitary HCC ≤ 5 cm and PHT.

作 者:邹浩 吴力群
DOI:10.3760/cma.j.issn.1673-9752.2018.10.010
基金项目:山东省重点研发计划(2018GSF18233)
过刊浏览 优先数字出版

提示:期刊搜索栏可按特定关键词、作者、单位、栏目或日期进行搜索相关期刊。

你也可以直接点击期刊目录进行浏览。

期刊目录
2018 年
2017 年
2016 年
2015 年
2014 年
2013 年
2012 年
2011 年
2010 年
2009 年
2008 年
2007 年