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目的综合分析影响肝癌患者介入治疗预后的主要因素,重点探讨肝癌的CT三维形态学对生存率的影响。方法对经过介入治疗的166例肝癌患者进行回顾性分析,所有患者术前及术后4周至2个月行CT扫描,明确术前肿瘤的容积、肿瘤与肝脏容积百分比(瘤肝比)等形态学特征,统计患者的一般资料和临床资料,并随访患者生存期。应用SPSS10.0统计分析软件,先进行各变量对生存率影响单因素分析,再对单因素分析有意义的变量行多因素Cox回归分析,采用Kaplan-Meier法计算累积生存率,log-rank检验方法检验2组之间的生存曲线有无差别。结果全组总体6个月及1、2、3年累积生存率分别为:78.54%(125/160)、47.23%(62/141)、23.68%(19/123)、14.09%(5/113);中位生存期为12个月。单因素及多因素Cox回归分析对预后影响均有意义的变量有:瘤肝比、门静脉癌栓、治疗次数及治疗后甲胎蛋白变化。瘤肝比0～25%及26%～50%的患者与51%～70%的患者相比,前2组生存率较后者明显增高,3组中位生存期分别为18、12、7个月;瘤肝比>70%的肝癌患者介入疗效极差,中位生存期仅6个月。结论(1)肝癌的CT形态学特征对介入治疗预后的影响能作出客观的评价。(2)CT三维容积测量肝癌容积及瘤肝比较二维测量能更准确地体现肝癌大小对预后的影响,瘤肝比是影响肝癌介入治疗预后的具有统计学意义的指标。
Objective To comprehensively analyze the main factors influencing the prognosis of patients with hepatocellular carcinoma after interventional therapy, and to investigate the effect of three-dimensional CT morphometry of liver cancer on the survival rate. Methods A total of 166 patients with hepatocellular carcinoma (HCC) treated by interventional therapy were retrospectively analyzed. CT scan was performed in all patients before and 4 weeks to 2 months after surgery. The volume of tumor before operation and the percentage of tumor to liver volume (tumor-to-liver ratio) Characteristics of learning statistics, general information of patients and clinical data, and follow-up of patient survival. Using SPSS10.0 statistical analysis software, univariate analysis was performed on the effect of each variable on survival rate. Cox regression analysis was performed on variables with significance for univariate analysis. The cumulative survival rate was calculated by Kaplan-Meier method. The log-rank test Methods Tests for any difference in survival curves between the two groups. Results The cumulative survival rates at 6 months and 1,2,3 years were 78.54% (125/160), 47.23% (62/141), 23.68% (19/123), 14.09% (5/113) ); Median survival was 12 months. Univariate and multivariate Cox regression analysis of prognostic significance of variables: tumor size, portal vein tumor thrombus, the number of treatment and treatment of alpha-fetoprotein changes. The survival rates of the first 2 groups were significantly higher than those of 0 ~ 25% and 26% ~ 50% of the patients compared with those of 51% ~ 70%. The median survival of the 3 groups were 18, 12 and 7 Months; tumor-to-liver ratio> 70% of patients with liver cancer interventional efficacy is poor, the median survival of only 6 months. Conclusion (1) CT morphological characteristics of liver cancer can influence the prognosis of interventional therapy objectively. (2) Three-dimensional CT volume measurement of liver cancer volume and tumor comparison Two-dimensional measurement can more accurately reflect the size of liver cancer prognosis, tumor-liver ratio is a prognostic indicator of the prognosis of liver cancer with statistical significance.