聚乙烯醇化疗栓塞治疗晚期肝细胞癌合并动-门静脉分流的临床疗效与生存预后分析

Chemoembolization with polyvinyl alcohol for advanced hepatocellular carcinoma with arterio-portal shunts:Efficacy and survival prognostic factors

目的评价聚乙烯醇(PVA)化疗栓塞治疗晚期肝细胞癌(HCC)合并动-门静脉分流(A-PVS)的临床疗效及生存预后因素。方法回顾性分析149例HCC合并A-PVS的临床资料,分为A组(58例,门静脉主干癌栓)与B组(91例,门静脉分支癌栓)。依据分流速度,采用不同规格PVA化疗栓塞。随访并分析生存期、术后并发症等。采用KaplanMeier法、log-rank检验计算并比较累积生存率,生存预后因素采用Cox模型分析。结果 149例患者的中位生存期(OS)为10.5个月,6、12个月的生存率分别为76.80%、41.00%。A组与B组中位OS分别为8.3个月和12.4个月,两组间差异有统计学意义(χ2=6.05,P=0.01)。A组和B组6、12个月的生存率分别为71.70%、25.30%和78.80%、52.30%。术后急性肝衰竭2例,上消化道出血3例。多因素分析显示,门静脉主干癌栓形成(HR=1.77,P=0.01)、Child-Pugh B级(HR=1.96,P=0.003)及肿瘤负荷≥50%(HR=3.22,P<0.001)为独立危险因素,而奥沙利铂总量>100mg(HR=0.42,P<0.001)为独立保护因素。结论 PVA化疗栓塞治疗晚期肝癌合并A-PVS安全、有效。奥沙利铂较大总量(>100mg)的患者预后较好,而门静脉主干癌栓形成、Child-Pugh B级及肿瘤负荷≥50%的患者预后较差。

Objective To evaluate the efficacy and survival prognostic factors of polyvinyl alcohol（PVA）chemoembolization for treating advanced hepatocellular carcinoma（HCC）with arterio-portal shunts（A-PVS）.Methods Clinical data of totally 149 patients with Advanced HCC and A-PVS were retrospectively analyzed.According to the degree of portal vein（PV）invasion,the patients were divided into group A（main portal vein invasion,n=58）and group B（branch PV invasion,n=91）.Based on A-PVS types,different sizes of PVA were used to embolize the shunt.The overall survival（OS）,postoperative complications were mainly followed and analysised.Survival curves were calculated by Kaplan-Meier method and compared statistically by log-ranktest.Survival prognostic factors were assessed by multivariate Cox proportional hazard model.Results The median OS of 149 patients was 10.5months.The 6-month,12-month survival rate was 76.80%and 41.00%,respectively.The median OS of the group A and group B was 8.3months and 12.4months,respectively.There was statistical difference of OS between the two groups（χ~2=6.05,P=0.01）.For group A,the 6-month and 12-month survival rate of were 71.70% and 25.30% while those were 78.80% and 52.30%for group B.After embolization,there were 2cases of acute liver failure and 3cases of upper gastrointestinal bleeding.The Cox multivariate survival analysis revealed that main portal vein invasion（HR=1.77,P=0.01）,Child-Pugh B class（HR=1.96,P=0.003）and tumor burden≥50%（HR=3.22,P0.001）were independent risk factors.While amount of oxaliplatin used100mg（HR=0.42,P0.001）was an independent protection factor.Conclusion It is s safe and effective method for the treatment of Advanced HCC with A-PVS by PVA chemoembolization.The patients with Advanced HCC and A-PVS achieved good survival prognosis with amount of oxaliplatin used100mg,while with main PV invasion,Child-Pugh B class and tumor burden≥50%indicated poor survival prognosis.