国际肿瘤学杂志

国际肿瘤学杂志 ›› 2016, Vol. 43 ›› Issue (2): 99-.

• 论著 • 上一篇    下一篇

肝动脉化疗栓塞术及射频消融术联合调强放疗治疗原发性肝癌合并门静脉癌栓的疗效及预后因素分析

于广计, 李强, 刘松, 王庆东   

  1. 山东省临沂市肿瘤医院介入科
  • 出版日期:2016-02-08 发布日期:2015-12-28

Efficiency and prognostic factors of transcatheter arterial chemoembolization, radiofrequency ablation combined with intensity modulated radiotherapy for hepatocellular carcinoma with portal vein tumor thrombus

 YU  Guang-Ji, LI  Qiang, LIU  Song, WANG  Qing-Dong   

  1. Department of Intervention, Linyi Cancer Hospital, Shandong Province, Linyi 276000, China
  • Online:2016-02-08 Published:2015-12-28

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1250

被引次数

9

摘要： 目的 探讨肝动脉化疗栓塞术及射频消融术联合调强放疗治疗原发性肝癌合并门静脉癌栓的疗效，并分析相关预后因素。方法 回顾性分析63例原发性肝癌伴门静脉癌栓患者的临床资料，所有患者先行肝动脉化疗栓塞治疗1～3次，然后射频消融治疗肝内原发灶，最后采用调强放疗针对门静脉癌栓行外照射治疗。放疗结束后6～8周观察癌栓及肝内肿瘤的近期疗效，随访1、2、3年生存率观察远期疗效，对可能影响预后的因素进行分析。结果 近期疗效中门静脉癌栓完全缓解9例(15.0%)，部分缓解36例(60.0%)，稳定10例(16.7%)，进展5例(8.3%)，癌栓有效率为75.0%；肝脏原发肿瘤完全缓解19例(31.7%)，部分缓解30例(50.0%)，稳定6例(10.0%)，进展5例(8.3%)，肝内肿瘤有效率为81.6%。1、2、3年生存率分别为73.3%、45.0%、27.0%。美国东部肿瘤协作组（ECOG）评分（χ2=53.046，P=0.000）、肝炎病史（χ2=6.472，P=0.030）、肿瘤大小（χ2=7.293，P=0.026）、肿瘤数目（χ2=24.382，P=0.000）、癌栓类型（χ2=28.085，P=0.000）、肝功能ChildPugh分级（χ2=6.184，P=0.040）是影响患者远期疗效的危险因素。结论 肝动脉化疗栓塞术联合射频消融术治疗肝内原发肿瘤，调强放疗治疗门静脉癌栓疗效较好，不良反应低，肿瘤反应率高；ECOG评分、肝炎病史、肿瘤大小及数目、癌栓类型、肝功能分级是影响其长期疗效的影响因素。

关键词: 肝肿瘤, 导管消融术, 放射疗法

Abstract: Objective To investigate the efficacy and prognostic factors of transcatheter arterial chemoembolization (TACE), and radiofrequency ablation (RFA) combined with intensity modulated radiotherapy (IMRT) for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Methods Sixtythree cases of HCC with PVTT were retrospectively analyzed. All of them received 13 time(s) of TACE therapy followed by RFA. IMRT was finally performed to PVTT. Both the therapeutic effects of HCC and PVTT were observed in 6 to 8 weeks after IMRT therapy. The longrun efficacy was observed by analyzing the 13 year(s) survival rate, and the hazards to prognosis were analyzed. Results The CR, PR, SD, PD numbers and rates in PVTT were 9 cases (15.0%), 36 cases (60.0%), 10 cases (16.6%), and 5 cases (8.3%). The effective rate in PVTT was 75.0%. Meanwhile the CR, PR, SD, PD numbers and rates in HCC were 19 cases (31.6%), 30 cases (50.0%), 6 cases (10.0%), and 5 cases (8.3%). The effective rate in HCC was 81.6%. The 1, 2 and 3 year survival rates were 73.3%, 45.0% and 27.0%, respectively. ECOG score (χ2=53.046， P=0.000), history of hepatitis (χ2=6.472， P=0.030), tumor size (χ2=7.293， P=0.026), the number of tumor（χ2=24.382， P=0.000）, the types of tumor thrombus (χ2=28.085， P=0.000) and ChildPugh class（χ2=6.184， P=0.040）were independent hazardous factors for survivals. Conclusion TACE combined with RFA is effective treatment for HCC with PVTT patients with low frequency of severe complications and high rate of tumor response. ECOG score, history of hepatitis, the size and number of tumor, the types of tumor thrombus, ChildPugh class are the factors that influence the long curative effect.

Key words: Liver neoplasms, Catheter ablation, Radiotherapy