双途径化疗治疗肝癌并发门静脉癌栓患者对预后的影响

A three year-followed up of patients with hepatocellular carcinoma complicated by portal vein tumor thrombus receiving TACE and PVC after resection of tumors

目的探讨经药物传输泵(DDS)门静脉化疗(PVC)联合肝动脉插管化疗栓塞(TACE)]治疗肝细胞癌伴门静脉癌栓的临床疗效及安全性。方法对87例肝细胞癌合并门静脉癌栓患者手术切除肿瘤并取出癌栓,再随机将患者分成3组。A组行TACE、B组行经DDS泵PVC,C组行经DDS泵PVC联合TACE。随访3年。结果 C组患者术后6个月、1年、2年和3年无瘤生存率分别为93.5%、80.6%、41.9%和29.0%,累积生存率分别为96.8%、87.1%、54.8%和45.2%,其中2年和3年生存率显著高于A组和B组(P均<0.05);C组患者术后6个月、1年、2年和3年上消化道出血发生率分别为0%、0%、16.1%和22.6%,与A组和B组比无显著性差异(P均>0.05)。结论对肝细胞癌合并门静脉癌栓患者行手术切除肿瘤并取出癌栓后,行双途径化疗可有效提高患者无瘤生存率及累计生存率。

Objective To observe the survival of patients with hepatocellular carcinoma（HCC）complicated by portal vein tumor thrombus （PVTT）receiving transcatheter arterial chemoembolization （TACE）and portal vein chemotherapy（PVC）after resection of tumors. Methods Eighty-seven patients with HCC complicated by PVTT had tumor resection and removal of PVTT. After the operation,the patients were randomly divided into three groups. The patients in group A,B and C were treated by TACE,by PVC and by TACE combined with PVC,respectively. The patients in the three groups were followed-up for three years. Results The tumor free survivals in group C six months,one year,two years and three years after the treatment were 93.5%,80.6%,41.9% and 29.0%,and the accumulative survival rates were 96.8%,87.1%,54.8% and 45.2%,respectively. Out of them,the survivals at two and three years were much higher than those in group B and C （P〈0.05）;the incidence of upper gastrointestinal bleeding in group C in six months,one year,two years and three years were 0%,0%,16.1% and 22.6%,respec-tively,without significant difference as compared to those in group A and B （P均〉0.05）. Conclusion The TACE and PVC are alternative approach in patients with HCC complicated by PVTT,which might improve the tumor-free survival and the accumulative survival rates.