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目的探讨沙利度胺(TLD)与TACE术联合应用对减少原发性肝癌介入术后的复发转移和延长生存期的效果。方法对80例行TACE术治疗的原发性肝癌患者随机分治疗组和观察组各40例,治疗组在TACE术的基础上加口服TLD由100mg/d递增至200mg/d或300mg/d,至少连续服用1个月,最长口服8个月。对照组不用TLD。每次介入术前或结束疗程后第1个月及以后每3个月复查CT/MRI,对病灶复发转移情况进行评价,同时作生存分析。结果治疗组与对照组平均复发或转移时间分别为148d(95%可信区间82~260d)和81d(95%可信区间30~180d),两组差异有统计学意义(P<0.05)。中位生存期分别为19个月(95%可信区间11~26月)和12个月(95%可信区间10~16月),两组差异有统计学意义(P<0.05)。治疗组6个月、12个月、18个月、24个月生存率分别为:治疗组:92.5%(37/40)、77.5%(31/40)、55.0%(22/40)、40.0%(16/40);对照组:80.0%(32/40)、50.0%(20/40)、40.0%(16/40)、22.5%(9/40)。采用χ2检验结果,P值分别为:0.105、0.01、0.01、0.007。结论沙利度胺联合TACE术,能延长原发性肝癌患者介入术后复发转移发生时间,并能适当延长中位生存期。
Objective To investigate the effect of combination of thalidomide (TLD) and TACE on reducing recurrence and metastasis and prolonging survival after interventional therapy of primary liver cancer. Methods Totally 80 patients with primary hepatocellular carcinoma treated with TACE were randomly divided into treatment group (40 cases) and observation group (40 cases). The treatment group was given TLD from 100mg / d to 200mg / d or 300mg / d on the basis of TACE, Take at least one consecutive month, the longest oral 8 months. The control group did not use TLDs. The CT / MRI was reviewed before or after the first month and every 3 months after the end of each course of intervention to evaluate the recurrence and metastasis of the lesion and to make a survival analysis. Results The mean recurrence or metastasis of the treatment group and the control group were 148 days (95% confidence interval 82-260d) and 81 days (95% confidence interval 30-180d), respectively. There was significant difference between the two groups (P <0.05). The median survival was 19 months (95% confidence interval 11-26 months) and 12 months (95% confidence interval 10-16 months), respectively, with significant differences between the two groups (P <0.05). The survival rates of the treatment group at 6, 12, 18 and 24 months were 92.5% (37/40), 77.5% (31/40), 55.0% (22/40), 40.0 % (16/40); control group: 80.0% (32/40), 50.0% (20/40), 40.0% (16/40) and 22.5% (9/40). Using χ2 test results, P values were: 0.105,0.01,0.01,0.007. Conclusions Thalidomide combined with TACE can prolong the recurrence and metastasis of patients with primary liver cancer after PCI, and prolong the median survival time appropriately.