肝癌肝移植术后骨转移的放射治疗及其对预后的影响

Radiotherapy for bone metastases of hepatocellular carcinoma after liver transplantation

目的通过回顾性分析肝细胞肝癌(以下简称肝癌)肝移植后骨转移患者的临床特征、放疗疗效及预后因素,探讨其有效治疗方法。方法 随访853例肝癌患者。其中30例在肝移植后出现骨转移,接受针对骨转移部位放疗,剂量范围8～60 Gy(中位剂量为40 Gy)。用Kaplan-Meier法进行生存分析,单因素分析用Log-rank方法,多因素分析采用Cox回归模型Backward-Wald法。结果 30例患者肝移植后出现骨转移,1年、2年生存率分别为39.7%、24.4%,中位生存时间8.6月。96.7%的患者接受放疗后疼痛缓解(29/30)。放疗剂量在30～60 Gy之间对疼痛的缓解在剂量效应关系上无相关性(P=0.670)。结论 放疗可以缓解肝细胞癌患者肝移植后骨转移的疼痛,从而提高患者的生存质量。

Objective To evaluate the efficacy of radiotherapy （RT） for patients with bone metastases （BM） from hepatocellular carcinoma （HCC） after liver transplantation （LT）. Methods Among 853 patients with HCC and liver transplantation, 30 had bone metastases during the follow-up and received external-beam radiotherapy （EBRT）. EBRT was performed with a dose of 8 ~ 60 Gy （median dose ：40 Gy） based on CT, MRI, ECT findings and focused on bone metastasis lesions with serious pain or high risk of pathologic fracture. The survival of patients was analyzed with Kaplan-Meier curves, log-rank tests, and multivariate COX regression analysis （backward wald）. Results The 1-,2-year survival rates and median survival since BM were 39.7% ,24.4% and 8.6 months, respectively. 96.7% patients got pain relief after EBRT. There was no significant difference in pain relief in the dose range of 30 ~ 56 Gy （ P = 0. 670）. Conclusion EBRT is an effective treatment to improve the quality of survival for patients with bone metastases from hepatocellular cell carcinoma after liver transplantation.