| 梁帅兵,谭杰,向斌.中晚期肝细胞癌经TACE后预后危险因素[J].中国介入影像与治疗学,2024,21(11):659-664 |
| 中晚期肝细胞癌经TACE后预后危险因素 |
| Risk factors of prognosis of intermediate and advanced hepatocellular carcinoma after TACE |
| 投稿时间：2024-08-27 修订日期：2024-10-10 |
| DOI：10.13929/j.issn.1672-8475.2024.11.003 |
| 中文关键词: 癌，肝细胞 化学栓塞，治疗性 肿瘤转移 |
| 英文关键词:carcinoma,hepatocellular chemoembolization,therapeutic neoplasm metastasis |
| 基金项目: |
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| 中文摘要: |
| 目的 分析中晚期肝细胞癌（HCC）经TACE后预后危险因素。方法 回顾性纳入103例以TACE作为初始治疗的中晚期HCC患者，随访TACE后肝外转移（EHM）及总生存时间（OS）。以单因素及多因素Cox回归分析临床信息、实验室检查、影像学及TACE资料，观察中晚期HCC经TACE后EHM及OS的危险因素。结果 首次TACE后1个月，103例中，84例客观缓解、19例治疗无效；随访3～50个月、中位时间16.9个月，期间34例发生EHM，70例死亡。治疗前甲胎蛋白（AFP）≥400 ng/ml（HR=3.451）及首次TACE无效（HR=3.049）均为中晚期HCC经TACE后EHM的独立危险因素（P均＜0.05）。治疗前碱性磷酸酶（ALP）≥100 U/L（HR=2.193）、血小板/淋巴细胞比值（PLR）≥125（HR=1.737）、肝功能Child-Pugh B级（HR=2.417）及首次TACE后1年内EHM（HR=4.488）均为OS独立危险因素（P均＜0.05）。结论 治疗前AFP≥400 ng/ml及首次TACE无效均为中晚期HCC经TACE后发生EHM的独立危险因素；治疗前ALP及PLR升高、肝功能下降及首次TACE后早期发生EHM均可使OS缩短。 |
| 英文摘要: |
| Objective To investigate the risk factors of prognosis of intermediate and advanced hepatocellular carcinoma （HCC） after TACE. Methods Totally 103 patients with intermediate and advanced HCC who underwent TACE as initial treatment were retrospectively enrolled， and extrahepatic metastasis （EHM） and overall survival （OS） after TACE during follow-up were recorded. Basic clinical information， laboratory and imaging examinations as well as TACE related data were analyzed with univariate and multivariate Cox regression analysis to screen the risk factors of EHM and OS after TACE in patients with intermediate and advanced HCC. Results One month after the first TACE， among 103 cases， objective remission was observed in 84 cases， while no response was noticed in 19 cases. During follow-up of 3—50 months （median of 16.9 months）， EHM occurred in 34 cases， and 70 cases died. Before TACE α-fetoprotein （AFP）≥400 ng/ml （HR=3.451） and ineffective initial TACE （HR=3.049） were both independent risk factors for EHM in intermediate and advanced HCC after TACE （both P＜0.05）. Before treatment alkaline phosphatase （ALP）≥100 U/L （HR=2.193）， platelet to lymphocyte ratio （PLR）≥125 （HR=1.737）， liver function Child-Pugh stage B （HR=2.417） and EHM within 1 year after the initial TACE （HR=4.488） were all independent risk factors for OS （all P＜0.05）. Conclusion Before treatment AFP≥400 ng/ml and ineffective initial TACE were both independent risk factors for EHM in intermediate and advanced HCC. Increased ALP and PLR， decreased liver function before TACE and early EHM after the initial TACE might shorten OS of patients with intermediate and advanced HCC. |
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