PVA-TACE治疗肝细胞癌并肝肺分流的临床疗效及预后分析

Polyvinyl alcohol chemoembolization for hepatocellular carcinoma with hepatopulmonary shunting:clinical efficacy and prognostic factors

目的 评价TACE）治疗肝细胞癌并肝肺分流（HPS）的临床疗效生存预后因素。方法 回顾性分析42例并HPS，依据分流途径分为门静脉-腔静脉分流组（A组，9例）与肝动脉-肝静脉分流组（B组，33例）。依据分流速度采用不同规格PVA）微粒进行肝动脉化疗栓塞治疗，随访并分析生存期及术后并发症。采用Kaplan-Meier法计算累生存率，采用Cox模型分析生存预后因素。结果 42例患者中位生存期（OS）为9.5个月，6、12个月生存率分别为74.9%、39.4%。A组与B组中位OS分别为10.5个月、9.5个月，两组生存期无差异（χ^2=0.410，P=0.522）。Cox分析结果显示：PS）评分较高（HR=2.454，=0.026）、肿瘤负荷＞50%（HR=3.477，=0.019）及门静脉主干癌栓形成（=0.006）为独立危险因素，而多次栓塞（HR=0.329，=0.008）为独立保护因素。结论 TACE治疗HCC合并HPS安全、有效。经多次栓塞治疗患者预后较好，而PS评分较高、肿瘤负荷较大及门静脉主干癌栓形成的患者预后不良。

Objective To evaluate the efficacy and survival prognostic factors of olyvinyl alcohol （PVA） chemoembolization to hepatocellular carcinoma （HCC） with hepatopulmonary shunting （HPS）. Methods A total of 42 patients’ managements were retrospectively analyzed. According to the shunting pathway, the patients were divided into group A （portal-systemic shunting,n=9） and group B （arterio-hepatic vein shunt,n=33）. Based on shunting degrees, different sizes of PVA were used to embolize the shunts. The overall survival （OS） and postoperative complications etc. were followed and analysised. Survival prognostic factors were assessed by univariate Kaplan-Meier analysis with log-rank test and a multivariate Cox proportional hazard model. Results The median OS of 42 patients was 9.5 months, and the 6-month, 12-month survival rate of 42 patients were 74.9% and 39.4%, respectively. The median OS of the group A and group B were 10.5 months and 9.5 months, respectively. There were no different significantly between two groups （χ^2=0.410,P=0.522）. Cox multivariate survival analysis revealed that higher performance status （PS） score （HR=2.454, P=0.026）, tumor burden 〉50% （HR=3.477=0.019） and main portal vein invasion （p=0.006） were independent risk factors. While multiple embolization （HR=0.329, P=0.008） was an independent protection factor. Conclusion It is safe and effective for selected HCC patients with HPS treated with PVA chemoembolization. HCC with HPS patient achieves good survival prognosis with multiple embolization, tumor burden 〉50%main portal vein invasion indicate poor survival prognosis.