经导管动脉内化疗治疗高龄原发性肝癌患者生存分析

Transcatheter Arterial Chemoembolization in Elderly Patients with Primary Hepatocellular Carcinoma

目的近年老年原发性肝癌（HCC）患者逐渐增加,其多合并全身疾病、心肺功能差,只能接受非手术治疗。本文评价经导管肝动脉化疗栓塞（TACE）治疗高龄HCC患者的疗效,探讨影响TACE治疗患者预后的因素。资料与方法经B超、CT或MRI检查诊断为HCC、并接受TACE治疗的106例患者,平均年龄（74.9±3.3）岁（71-84岁）,分析其临床特点、生存情况,并探讨其预后影响因素。结果本组患者中位随访时间18（1-40）个月,中位生存时间23.0个月,1、2、3年生存率分别为80.2%、42.5%、22.6%。单因素分析结果显示,患者性别、肝硬化、病毒感染、糖尿病、全身疾病不是影响高龄HCC患者生存的因素（P〉0.05）,Child-Pugh分级、美国东部肿瘤协作组（ECOG）评分、肿瘤大小、肿瘤数量、血清甲胎蛋白（AFP）水平、门静脉癌栓形成及BCLC分期是影响高龄HCC患者长期生存的因素（P〈0.05、P〈0.001）。多因素Cox回归分析结果显示,有无门静脉癌栓、肿瘤大小、血清AFP水平及ECOG评分是影响高龄HCC患者预后的独立危险因素（P〈0.05、P〈0.001）。结论伴有全身疾病不是影响高龄HCC患者长期生存的因素,影响高龄肝癌患者预后的危险因素是有无门静脉癌栓、肿瘤大小、血清AFP水平及ECOG评分。

Purpose Elderly patients with primary hepatocellular carcinoma （HCC） have gradually increased in recent years. Most patients also have systemic disease with poor cardiac and pulmonary function, thus can only receive non-surgical treatment. This paper is to assess the clinical efficacy of transcatheter arterial chemoembolization （TACE） and prognostic factors of HCC in elderly patients. Materials and Methods A retrospective analysis was performed in 106 patients with HCC diagnosed by US, dynamic CT or dynamic MRI [average age （74.9±3.3） years, range 71-84 years] and treated by TACE. The clinical characteristics, survival and prognosis factors were analyzed. Results Follow-up was performed at a median of 18 months （range 1-40 months）. The 1-, 2-. and 3-year overall survival （OS） rates were 80.2%, 42.5% and 22.6%, respectively. Univariate analysis showed that the patient＇s gender and cirrhosis, HBV/HCV infection, diabetes and systemic disease were not significantly correlated with prognosis （P〉0.05）. Child grade, Eastern Cooperative Oncology Group （ECOG） grade, tumors size, number of tumors, serum alpha-fetoprotein level, portal vein tumor thrombus and Barcelona clinic liver cancer stage were significantly related to OS （P〈0.05, P〈0.001 ）. Moreover, the Cox mu[tivariant survival analysis revealed that portal vein tumor thrombus, tumor size, serum alpha-fetoprotein level and ECOG stage were independent prognostic indicators （P〈0.05, P〈0.001）. Conclusion Systemic disease does not impact long-term survival in elderly patients with HCC. Portal vein tumor thrombus, tumor size, serum alpha-fetoprotein level, and ECOG grade are independent prognostic indicators.