剂量分割模式对肝癌放射治疗预后影响的探讨

Prognostic impact of the fraction dose regimen in liver cancer radiotherapy

目的 分析肝癌放射治疗的预后影响因素,探讨剂量分割模式与预后的关系.方法 行放射治疗的287例肝癌病例,放射治疗的总剂量为（51.60±7.19） Gy,中位52 Gy,分割剂量（4.54±1.02）Gy,中位4.50 Gy,照射次数（12.10±4.19）次,中位次数12次,每周3～5次,每日或隔日1次.肝癌分期采用CUPI评分系统,运用Kaplan-Meier法计算生存率、绘制生存曲线图,并进行单因素统计分析.采用Cox回归（比例风险模型）方法对可能影响预后的临床相关因素进行多因素分析,并探讨剂量分割模式与肝癌放射治疗预后的关系.结果 肝癌放射治疗总有效率（CR＋ PR）为47.39％（136/287）,1、3、5年总生存率分别为54.4％、29.2％、14.2％.肝癌放射治疗预后的独立预后因素有：CUPI评分、性别、GTV、PVTT、Child-Pugh分级及剂量分割模式,以上因素对预后的影响有统计学意义（P均＜0.05）.分割剂量预测肝癌患者放射治疗预后的ROC曲线下面积为0.661 （95％ CI：0.568～0.754）,最佳判断界值为4.75Gy.采用（49.85±4.37） Gy/4.75 ～ 6.0 Gy/次,分8 ～11次2.5周～3.5周完成的剂量分割模式的预后是较好的,中位生存期为23个月,1、3、5年生存率分别为72％、43.6％、28％.结论 CUPI评分、性别、GTV、PVTT、Child-Pugh分级和剂量分割模式是影响肝癌放射治疗预后的独立因素,采用合适剂量分割模式的放疗可以获得更高的生存率.

Objective To analyze the prognostic factors of fractional radiotherapy for liver cancer, and to investigate the relationship between the fraction dose regimen and prognosis. Methods 287 cases of liver cancer received fractional radiotherapy with a total dose of （51.60 ± 7. 19）Gy/（4. 54 ± 1.02）Gy per fractions/3-5fractions per week, total （12.10 ±4.19） fractions. Chinese University Prognostic Index （CUPI） was used for liver cancer staging. The prognostic factors include： CUPI, gender, age, GTV, GTD, HBV, TACE, PVTr, radiotherapy dose, liver function Child-Pugh classification and the fraction dose regimen. The cumulative survival rates were calculated by using the Kaplan-Meier method, and were statistically compared using the log-rank test. Multivariate analysis was performed using the Cox proportional hazard regression model. Results The response rate （ CR ＋ PR） was 47.39% （ 136/287 ）. The 1 - ,3 -, and 5-year overall survival rate was 54.4% , 29.2% and 14.2% , respectively. Independent significant prognostic factors were CUPI, Gender, GTV, PVTI＇, Ghild-Pugh Class and the fraction dose regimen （P 〈0.05）. The fraction dose prediction in patients with liver cancer radiotherapy prognosis of the area under the ROC curve was 0. 661 （95% CI：0. 568 -0. 754）, the best judgment sector is 4.75Gy. The fraction dose （49.85±4.37） Gy/ 4.75Gy-6.0Gy per fractions group is the best prognosis, with a median survival time of 23 months. 1 - , 3 - and 5-year survival rates were 72% , 43.6% , 28%. Conclusion CUPI, Gender, GTV, PVTT, Child-Pugh Class and the fraction dose regimen are independent factors. For those with liver cancer, the appropriate fraction dose regimen is closely related to a higher survival rate.