晚期胆管癌三维适形放疗疗效评价及预后因素分析

Evaluation of the efficacy of three-dimensional conformal radiotherapy and analysis of prognostic factors in advanced cholangiocarcinoma

目的 探讨晚期胆管癌三维适形放射治疗（three-dimensional conformal radiotherapy 3DCRT）的疗效及相关因素对预后的影响。方法 回顾分析了45例晚期胆管癌3DCRT患者的资料。用Kaplan—Meier法计算患者的生存率；通过Cox比例风险模型对晚期胆管癌行3DCRT的患者进行多因素分析。结果 晚期胆管癌经3DCRT后获得了82．2％（37／45）的肿瘤局部控制率。其1，2年生存率分别为53．3％（23／43）和16．3％（7／43），中位生存期为13．7个月。治疗后患者Karnofsky评分平均增高15．3分。治疗中33例患者出现1～2级急性胃肠道反应，5例出现3级胃肠道反应，5例放疗后1～3个月内出现十二指肠溃疡，2例发生胃溃疡，其中1例因十二指肠溃疡大出血死亡，其余6例经对症处理后好转。Cox比例风险模型多因素分析结果显示，年龄、内引流术、淋巴结转移和Karnofsky评分对患者生存率的影响有统计学意义（P〈0．05）。结论 3DCRT对晚期胆管癌患者局部治疗效果明显，能有效提高患者的生存率和生活质量，而年龄、内引流术、淋巴结转移和Kamofsky评分是患者预后的重要影响因素。

Objective To explore the efficacy of three-dimensional conformal radiotherapy （3DCRT） and the influence of relevant factors on the prognosis of advanced cholangiocarcinoma. Methods A retrospective analysis of 45 patients with adveanced cholangiocarcinoma who were treated with 3DCRT was made. The survival rate was computed using Kaplan-Meier analysis, and the factors that might influence the prognosis of advanced cholangiocarcinoma were analyzed with the Cox proportional hazard model in multivariate analysis. Results The local control rates was 82. 2%, the 1-year, 2-year survival rates were 53.3% and 16. 3% respectively, and the median survival period was 13. 7 months. After treatment, the score of Karnofsky by 15.3 in average. Thirty-three patients showd the acute gastrointestinal side effects of grade 1- 2, and 5 patients showed the grade 3 gastrointestinal reaction. Five patients developed duodenal ulcer and 2 patients developed stomach ulcer 1-3 months after radiotherapy. One of the above 7 patients died of massive gastrointestinal bleeding, and the remaining 6 patients were cured by the symptomatic treatment. The multivariate analysis showed that age, linternal drainage, lymphatic metastasis and scores of Karnofsky had statistical significance for the survival rate of the patients （ P 〈 0. 05）. Conclusion The local efficacy of 3DCRT in treatment of cholangiocarcinomas was satisfactory, It can improve obviously the survival rate and the quality of life of the patients with advanced cholangiocarcinoma. Age, internal drainage, lymphatic metastasis and scores of Karnofsky are the major prognosis factors.