HBV相关HPC伴PVTT患者癌栓仅侵犯分支微创治疗的分析

The Effect of Tumor Thrombus Site on the Efficacy of Minimally Invasive Treatment to HCC Patients with PVTT

目的分析比较HBV相关原发性肝细胞癌(HPC)伴门脉癌栓(PVTT)患者1年内发生死亡组与未发生死亡组的临床检测指标及影响学显示的癌栓所处部位,观察癌栓所处部位的不同对1年生存率的影响,以指导临床。方法回顾性分析初次确诊为HBV相关HPC伴PVTT符合纳排标准的患者191例,随访患者自确诊后一年内是否存活及存活时间,采集患者临床信息,计量资料采用t检验或秩和检验;计数资料采用x2检验,多因素回归采用COX回归分析筛选出发生死亡的独立危险因素。结果微创治疗及癌栓部位对HBV相关HPC癌伴PVTT的一年的生存率均有影响(P=0.003&P=0.000)。多因素COX回归分析显示:微创治疗与癌栓部位存在交互作用,P=0.001 HR=1.086,95%CI(1.034,1.141)。采用不同的微创治疗对癌栓部位仅侵犯分支的HBV相关HPC伴PVTT的患者的1年内的生存有影响,其中采用射频联合TACE治疗效果最佳。不同的微创治疗对癌栓部位仅侵犯主干和侵犯分支+主干的患者的1年生存没有影响。结论癌栓仅侵犯分支的HBV相关原发性肝癌伴PVTT患者是采用微创治疗的优势人群,且联合应用射频和TACE效果优于单独单独应用射频、TACE。

Objective This study aims to analyze the Clinical detection indicators and the location of tumor thrombus of the HBV-related hepatocellular carcinoma patients with portal vein tumor thrombus.To observe the influence of different Tumor thrombus locations on one-year survival. Methods Retrospectively including 191 patients whose initial diagnosis was HBV-related primary hepatocellular carcinoma with portal tumor thrombus in compliance with the standard;Following-up survival time of patients within one year after diagnosis.Collecting clinical information of patients,Using the t-test for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test for comparison of non-normally distributed continuous data between groups;Using the chi-square test for comparison of categorical data between groups;and Multivariate regression to identify independent risk factors ofdeath by Logistic regression analysis. Results Minimally invasive treatment and tumor thrombus sites have a significant effect on one-year survival rate of HBV-related HCC patients with PVTT.( P =0.003 & P =0.000)Multivariate COX regression analysis showed that there was a interaction between minimally invasive treatment and tumor thrombus sites [ P =0.001 HR=1.086,95%CI(1.034~1.141)].There were a difference on one-year survival curve of patients whose tumor thrombus only located in the branch among different minimally invasive treatments( P =0.015),in which the RFA combined with TACE has the best effect.There were no differences on one-year survival curve of patients whose tumor thrombus located in the trunk and both in the trunk and the branch among different minimally invasive treatments. Conclusion HBV-related HCC patients with PVTT that tumor thrombus only located in the branch arethe predominant group using minimally invasive treatments. The effect of Joint application of radio frequency and TACEeffect is superior to the separate appli cation of radio frequen- cy or TACE merely.