门静脉受侵肝细胞癌经动脉化疗栓塞治疗预后因素分析

HEPATOCELLULAR CARCINOMA WITH PORTAL VEIN INVASION:ANALYSIS OF PROGNOSTIC FACTORS IN TRANSCATHETER ARTERIAL CHEMOEMBOLIZATION

目的 评价经动脉化疗栓塞治疗门静脉受侵肝细胞癌的疗效及影响预后的因素。方法 门静脉受侵肝细胞癌6 3例 (男 5 9女 4 0 )。 2 3例行单纯明胶海绵栓塞 (组 1) ,11例行单纯碘化油栓塞 (组 2 ) ,2 9例行碘化油与明胶海绵栓塞 (组 3)。计算生存时间 ,并进行 L og rank检验。 Cox风险比例模型分析预后影响因素。结果 组 3的生存时间更长于组 1和组 2 (P<0 .0 5 )。组 1组 2的生存时间无统计学差异 (P>0 .0 5 )。组 1和组 3对门静脉瘤栓的回缩效果优于组 2 (P<0 .0 5 )。肝癌分期、肿瘤数目、治疗方法是对死亡风险有显著作用的预后因素。治疗方法中明胶海绵栓塞、明胶海绵与碘化油栓塞是生存时间的有利因素。结论 门静脉受侵肝细胞癌患者的预后与肝癌分期、肿瘤的数目和治疗方法密切相关。对于门静脉癌栓回缩及延长生存时间 。

Objective To evaluate the efficacy and the prognostic factors of transcatheter arterial chemoembolization(TACE) for hepatocellular carcinoma(HCC) with portal vein invasion.Methods 23 patients treated with GS(group 1);11 with LP (group 2);29 with GS and LP(group 3).Survival time in these groups was estimated according to the Kaplan-Meier method,and differences were calculated with the log rank test.A cox proportional hazard model was used to analyze prognostic factors including gender,age,tumor type,tumor volume,field of invasion,HCC stage,Child's class,position of tumor thrombus,collateral circulation,A-P shunts,methods of therapy,etc.Results Survival time in group 3 was longer than that in other two groups(P<0.05).Group 1 and 3 were better than group 2(p<0.05)for regression of tumor thrombus.Outcome showed that HCC stage(β=0.816,Exp(β)=2.261,p=0.006),number of tumors(β=0.965,Exp(β)=2.624,p=0.010),and methods of therapy(p<0.001)were the important factors.In methods of therapy,TACE with GS(β=-0.838,Exp(β)=0.433,p=0.043)and TACE with GS and LP(β=-1.557,Exp(β)=0.211,p<0.001)could significantly prolong the survival time of patients,especially the latter one,while HCC stage and number of tumors were its risk factors.Conclusion The prognosis of HCC patients with portal vein invasion is closely related with patient's HCC stage,number of tumors and methods of therapy.TACE with GS or with GS and LP can significantly make the thrombus regression and prolong the survival time.TACE with GS seems preferable to TACE without GS.