经导管动脉化疗栓塞对肝癌合并门静脉癌栓的疗效评价

Efficacy of transcatheter arterial chemoembolization for hepatocellular carcinoma complicated by portal vein tumor thrombus

目的:探讨经导管动脉化疗栓塞对原发性肝细胞癌合并不同分型门静脉癌栓的疗效和预后因素,并评价此标准对临床的指导意义。方法:回顾性收集中国医科大学附属第一医院介入病房2007年1月至2009年12月间符合纳入标准的201例肝细胞癌患者,所有病例均接受规律的经导管动脉化疗栓塞治疗,然后根据合并门静脉癌栓的位置不同而分为4型,并相应的分成四组(Ⅰ-Ⅳ组),最后对各组进行疗效和生存等统计学分析。结果:全部病例总缓解率为5.5%;有效率为48.3%;3个月、6个月、1年、2年及3年累积生存率分别为91.0%、81.1%、49.8%、15.4%和5.0%;中位生存时间为12个月。Ⅰ-Ⅳ组的中位生存期分别为20个月、11个月、9个月和3个月。多因素分析显示,门静脉癌栓分型,凝血酶原时间,治疗次数和疗效为影响肝细胞癌患者生存期的独立预后因素。结论:在肝脏功能储备良好的情况下,经导管动脉化疗栓塞是肝细胞癌的一种安全有效的治疗手段,并且随着合并门静脉癌栓位置不同,预后也不同,对Ⅰ型,Ⅱ型和Ⅲ型门静脉癌栓疗效较为显著,预后相对较好,但Ⅳ型预后较差。

Objective： The present retrospective study sought to validate the efficacy and survival bene？ ts of TACE and to identify prognostic factors in patients with HCC complicated by different types of PVTT. Methods： From January 2007 to December 2009,201 consecutive patients with inoperable or nontransplantable HCC complicated by PVTT and treated with a monotherapy of TACE were retrospectively evaluated. The study patients were classified into one of four groups according to the location of PVTT： type I,tumor thrombi involving segmental branches of the portal vein or above（ 71 cases）; type II,tumor thrombi involving right/left portal veins（ 81 cases）; type III,tumor thrombi involving the main portal vein trunk（ 37 cases）; or type IV,tumor thrombi involving the superior mesenteric vein（ 12cases）. The cumulative survival rate was estimated by the Kaplan-Meier method,and prognostic factors were obtained by univariate and multivariate analyses. Results： The median overall survival for all 201 study patients was 12 months,and their 6-month and 1,2 and 3-year overall survival rates were 81. 1%,49. 8%,15. 4% and 5. 0%,respectively. The prognosis of PVTT types I or II was better than types III or IV. Multivariate analysis showed that the type of PVTT,prothrombin time,number of TACE sessions,and therapeutic response were significant independent factors for survival time. Conclusion： TACE can be safely and effectively performed in select HCC patients with tumor thrombus invasion of the first,second,or lower branches of the portal vein and even the main portal vein,and can prolong the overall survival. However,the role of TACE in HCC patients with superior mesenteric vein tumor thrombus remains controversial.