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目的比较肝动脉化疗栓塞术(TACE)和肝切除术治疗晚期肝细胞癌(HCC)的疗效。方法回顾性分析436例晚期HCC患者的临床资料,其中332行肝切除术(肝切除组)、104例行TACE(TACE组),利用倾向性分析匹配组间基线资料的均衡性。比较两组患者的并发症发生情况、死亡率及生存情况。结果倾向性匹配后,肝切除组、TACE组分别纳入204例、102例,两组患者基线资料比较差异无统计学意义(P>0.05),可比性良好。倾向性匹配后,两组的并发症发生率、术后30 d及90 d死亡率比较,差异均无统计学意义(P>0.05);肝切除术组患者中位生存时间为17.0个月,长于TACE组的11.7个月(P<0.05),肝切除术组术后1年、3年、5年、7年总生存率为58.8%、22.3%、18.1%、18.1%,分别长于TACE组的48.7%、14.3%、12.3%、6.8%。结论对于晚期HCC患者,肝切除术的疗效优于TACE。
Objective To compare the efficacy of transcatheter arterial chemoembolization (TACE) and hepatectomy for the treatment of advanced hepatocellular carcinoma (HCC). Methods The clinical data of 436 patients with advanced HCC were retrospectively analyzed. 332 patients underwent hepatectomy (liver resection group) and 104 patients undergoing TACE (TACE group). The propensity analysis was used to match the baseline data of the patients. The incidence of complications, mortality and survival were compared between the two groups. After the results tended to be matched, 204 cases and 102 cases were included in the liver resection group and the TACE group, respectively. There was no significant difference in the baseline data between the two groups (P> 0.05). There was no significant difference in the complication rates between the two groups after 30 days and 90 days postoperatively (P> 0.05). The median survival time in the hepatectomy group was 17.0 months, (P <0.05). The overall survival rates at 1 year, 3 years, 5 years and 7 years after hepatectomy group were 58.8%, 22.3%, 18.1% and 18.1%, respectively, longer than TACE group 48.7%, 14.3%, 12.3%, 6.8%. Conclusions Hepatectomy is superior to TACE in patients with advanced HCC.