化疗栓塞终点对肝癌患者生存影响初探

Chemoembolization endpoints:Preliminary impact on the survival of patients with liver cancer

目的：调查肝癌患者动脉化疗栓塞（TACE）血管造影栓塞终点与生存的关系。方法回顾评价了210例行TACE的肝癌患者。根据预先确定的主观血管造影化疗栓塞终点尺，对案例进行了分级。用 K-M分析评价生存。用Cox比例风险回归模型来确定生存的独立预后风险因子。结果所有生存中值周期是21．2个月（95％ CI，15．4～26．9个月）。主观血管造影化疗栓塞，Ⅱ和Ⅲ级终点的栓塞患者26．5个月（95％ CI，16．0～35．2个月），比IV 级栓塞患者17．1个月（95％ CI，13．2～20．3个月）的生存中值周期显著要长（P＝0．035）。多变量分析的结果表明，所有下列因子都是独立存在的，消极的生存预后指标：主观血管造影化疗栓塞终点IV 级[危害比（HR），95％ CI，1．42～4．41；P＝0．002]。结论做TACE时，栓塞在居间位置，顺行血流部分淤滞的终点，与栓塞在较高位置、顺行血流淤滞的终点比较，生存率提高。肿瘤介入医生做TACE时，应考虑这些居间位置和前向血流部分淤滞的血管造影终点的目标。

Objective To explore the relation between angiographic embolic endpoints of TACE and the survival of patients with hepatocellular carcinoma （HCC）. Methods Two hundred and ten patients with HCC who underwent TACE were reviewed in this study. A previously established subjective angiographic chemoembolization endpoint scale had classified the cases. Survival was evaluated by Kaplan-Meier analysis. Independent prognostic risk factors of survival were determined by the Cox proportional hazards model. Results The overall median survival period was 21.2 months. Patients with embolization to subjective angiographic chemoembolization endpoint levels Ⅱ andⅢ were aggregated and had a significantly longer median survival period （26.5 months） than that of the patients with embolization to level Ⅳ （17.1 months） （P = 0. 035）. The results of multivariate analysis indicated that all of the following factors were independent negative prognostic indicators of survival; subjective angiographic chemoembolization endpoint level IV （P = 0.002）, American Joint Committee on Cancer stage Ⅲ or Ⅳ （P = 0. 007）, and Child-Pugh class B （P = 0. 025）. Conclusion Embolization to an intermediate, substasis endpoint during TACE improves survival compared with embolization to a higher stasis endpoint.