原发性肝癌骨转移的放射治疗疗效及相关预后因素的分析

Radiotherapy for primary liver neoplasms with bone matastases and analysis of related prognostic factors

目的 分析原发性肝癌骨转移患者的放射治疗疗效及预后的相关因素。方法 回顾性分析了 5 2例原发性肝癌伴骨转移放射治疗的效果 ,放疗方法采用常规分割 ,每周 5次 ,每次 2Gy ,中位肿瘤剂量 4 0 .0Gy。生存率用Kaplan Meier法计算 ,单因素分析采用log rank方法 ,多因素分析采用COX回归模型。 结果 1、2、3年生存率分别为 2 7.6 %、11.8%、8.9%。经单因素和多因素分析表明肝内病灶的控制情况、肝功能状况、肝内肿瘤灶的数目、骨转移时是否伴有其它脏器转移因素是独立的预后因子 (P值均 <0 .0 1)。骨转移灶的数目、诊断骨转移时AFP的水平与生存率无明显相关。结论 原发性肝癌骨转移患者经外照射后症状明显缓解 ,但远期疗效很差 ,绝大多数在一年内死亡。肝内病灶控制与否、肝功能的状况、肝内肿瘤灶的数目、骨转移时是否伴有其它脏器的转移与预后相关。

Objective To evaluate the outcome and prognosis of radiotherapy of primary liver cancer with bone metastasis. Methods To analyse retrospectively 52 cases of primary liver cancer with bone matastases. All patients received conventional radiation therapy with a median dose of 40.0 Gy,2 Gy per fraction ,5 fractions weekly.Survival rates were calculated by Kaplan-meier method, univariates analysed by log-rank and multivariates analysed by cox regression. Results The 1,2 and 3 year survival rates were 27.1%,11.8% and 8.9% respectively.Factors such as control of endohepatic lesion, liver function, number of hepatic lesion, and metastasis to other organs were independent prognostic factors, while number of bone metastasis, and AFP level had no significant relations with the survival rate. Conclusion Radiotherapy can significantly relieve patients' symptoms, but the long term effects are poor. The control of endohepatic lesion, function of the liver,number of hepatic lesions,and metastasis to other organs including bone metastasis were related factors of prognosis.