消化道肿瘤肝转移经肝动脉介入治疗的疗效评价及预后影响因素分析

Evaluation of efficacy and influence factors of transarterial interventional therapy in patients with liver metastasis from malignancy of alimentary tract

目的评价经肝动脉介入治疗(TAIT)消化道肿瘤肝转移的疗效,并探讨影响患者预后的因素。方法266例消化道肿瘤肝转移患者,原发肿瘤为结直肠癌161例,胃癌67例,食管癌22例,胃肠间质瘤16例。共行TAIT 754例次,观察其近期疗效、远期疗效和毒副反应,对可能影响患者预后的因素进行单因素分析和多因素Cox回归分析。结果总有效率为45.4%。中位生存期为14.3个月,0.5、1、2、3和5年生存率分别为83.1%、56.8%、17.7%、9.3%和1.5%。132例患者于TAIT后1～5 d内出现轻-中度肝区不适、疼痛、恶心呕吐、低热等,无严重毒副反应发生。原发肿瘤来源、肝转移瘤数目、肝转移瘤分布、是否伴有门静脉栓子、肿瘤血供情况、原发肿瘤是否切除是消化道肿瘤肝转移TAIT治疗后患者预后的独立影响因素。结论TAIT是治疗不能根治性切除肝转移瘤的有效姑息治疗方法。食管癌来源、多发肝转移、转移瘤累及多叶、伴有门静脉栓子的患者预后较差,而富血供肿瘤、原发肿瘤已切除的患者预后较好。

Objective To evaluate the efficacy and prognostic factors of transarterial interventional therapy （TAIT） in patient with liver metastasis from malignancy of the alimentary tract. Methods 266 patients with unresectable liver metastases from malignancy of the alimentary tract received totally 754 sessions of transarterial interventional therapy. Cox regression was used in the proportional hazard analysis. Results The overall response rate of TAIT was 45.4%, The median survival time （MS） was 14.3 months in this series. The 0.5-, 1-, 2-, 3-, 5-year cumulative survival rate （CSR） was 83.1%, 56.8%, 17.7%, 9.3% and 1.5%, respectively. No severe adverse reaction was observed except nausea, vomiting and mild fever as well as pain in the hepatic area. It was found that portal vein tumor thrombosis （PVTF） , the blood supply of tumor, metastasis from esophageal carcinoma, the number of metastasis, multi-lobe involvement, resection nature of primary tumor were independent factors affecting survival. Conclusion Transarterial interventional therapy is effective for treatment of liver metastasis from malignancy of the alimentary tract. Portal vein tumor thrombosis, metastasis from esophageal carcinoma, multiple metastatic lesions, multi-lobe involvement are poor prognostic factors, while complete resection of the primary tumor and rich blood supply of metastatic lesion are good independent prognostic factors.