化疗联合免疫治疗在提高肝癌合并门静脉癌栓术后疗效中的作用

Efficacy of postoperative chemotherapy combined with immunotherapy for hepatoceHular carcinoma with major portal vein tumor thrombus

目的研究手术切除联合门静脉免疫化疗对原发性肝癌(HCC)合并门静脉癌栓(PVTT)患者的临床疗效的影响。方法将2001年1月至2005年12月收治的76例原发性肝癌合并门静脉主干和(或)一级分支癌栓患者分为两组,A 组(n=29)行肿瘤切除加癌栓取出术,术后经门静脉行免疫化疗(5-氟尿嘧啶、阿霉素、顺铂、干扰素-α);B 组(n=47)仅行手术切除加癌栓取出术。比较两组患者生存率并对预后影响凶素进行分析。结果 A、B 两组6个月,1、2、3年牛存率分别为82.3%和52.7%,46.5%和20.2%,14.3%和5.8%,14.3%和5.8%,中位生存时间分别为11.5和6.0个月(P=0.010),其中无瘤生存分别为4.5和2.4个月(P=0.032)。多因素回归分析显示,影响总生存期的因素包括化疗、病理分级和肿瘤大小。影响无瘤生存期的因素包括化疗和病理分级。结论 HCC 合并 PVTT 患者采取手术切除联合门静脉免疫化疗是有效的。

Objective To evaluate the efficacy of surgical treatment combined with immunoehemotherapy via portal vein for hepatoeellular carcinoma （HCC） with major portal vein tumor thrombus（PVTF）. Methods Between January 2001 and December 2005 76 HCC patients with tumor thrombus in portal trunk and （or） the first-order branch were recruited into the study. Patients were divided into group A （n = 29 ） and B （n = 47 ）. Patients in group A were treated with hepateetomy plus portal thrombectomy in combination with postoperative adjuvant immunochemotherapy administered via portal vein. The immunochemotherapy regimen consisted of 5-Fluorouracil, Adriamycin, platinol and m-Interferon （PIAF）. Patients in group B were subjected to hepatectomy plus thrombectomy alone. Survival rates were compared between two groups, and prognostic factors were identified. Results Half-, One-, two- and three- year cumulative survival rates were markedly greater in group A than group B, being 82. 3% vs 52. 7% , 46. 5% vs 20. 2% , 14. 3% vs 5.8% , 14. 3% vs 5.8% , respectively. Group A had a significantly longer median survival time and median tumor-free survival time as compared with group B, being 11.5 months vs 6. 0 months （ P = 0. 010 ）, 4.5 months vs 2. 4 months （ P = 0. 032 ）, respectively. Multivariate analysis revealed that immunochemotherapy, pathological grading and tumor size were independent factors for survival times. And immunochemotherapy and pathological grading were independent factors for tumor-free survival time. Conclusions Surgical resection combined with adjuvant immunochemotherapy via portal vein represents as an effective modality for HCC with PVTF.