调强放疗联合索拉非尼治疗肝细胞癌合并门脉癌栓的疗效及预后因素分析

Analysis of therapeutic effect and prognostic factors of IMRT combined with sorafenib in the treatment of hepatocellular carcinoma with portal vein thrombosis

目的探讨调强放疗(IMRT)联合索拉非尼治疗肝细胞癌(HCC)合并门脉癌栓(PVTT)的疗效、安全性及预后影响因素。方法纳入76例HCC合并PVTT的患者,根据治疗是否同步索拉非尼分为IMRT+索拉非尼组(30例)和单纯IMRT组(46例)。比较2组临床一般资料、生存结局、不良反应。Kaplan-Meier法测定2年累积生存(OS)率、无进展生存(PFS)率、无远处转移生存(DMFS)率并行Log-rank检验,单因素及多因素Cox模型分析预后影响因素。结果IMRT+索拉非尼组与单纯IMRT组客观缓解率(ORR)分别为53.3%、43.5%(P>0.05)。IMRT+索拉非尼组中位生存时间长于单纯IMRT组(12.0个月vs.9.0个月)。IMRT+索拉非尼组与单纯IMRT组2年OS分别为23.8%和3.5%(Log-rankχ^(2)=6.271,P=0.012),2年PFS分别为7.5%和0(Log-rankχ^(2)=6.205,P=0.013),2年DMFS分别为9.5%和0(Log-rankχ^(2)=4.346,P=0.037)。多因素分析显示,未同步索拉非尼、AST/ALT>1.26、肿瘤无反应均为影响HCC合并PVTT患者生存质量的独立危险因素(均P<0.05)。2组不良反应发生率差异无统计学意义(P>0.05)。结论与单纯IMRT相比,IMRT同步索拉非尼改善了HCC合并PVTT患者的远期疗效,而未增加不良反应。AST/ALT<1.26、肿瘤有反应、IMRT同步索拉非尼的患者预后较好。

Objective To investigate the efficacy,safety and prognostic factors of intensity modulated radiation therapy(IMRT)combined with sorafenib in the treatment of hepatocellular carcinoma(HCC)with portal vein thrombosis(PVTT).Methods Seventy-six patients of HCC with PVTT were divided into two groups according to whether sorafenib was synchronized or not:IMRT+sorafenib group(n=30)and IMRT alone group(n=46).Clinical data,survival results and adverse reactions were compared between the two groups.Kaplan-Meier method was used to calculate the 2-year overall survival rate(OSR),progression free survival rate(PFSR),distant metastasis free survival rate(DMFSR),and Log-rank test was also used for the detection.The Cox model multivariate analysis was used for prognostic factors.Results The objective response rates(ORR)were 53.3%and 43.5%in IMRT+sorafenib group and IMRT alone group,respectively(P>0.05).The median survival time was longer in IMRT+sorafenib group than that in the IMRT alone group(12.0 vs.9.0 months).The 2-year OSR were 23.8%and 3.5%in IMRT+sorafenib group and IMRT alone group(Log-rankχ^(2)=6.271,P=0.012),PFSR were 7.5%and 0(Log-rankχ^(2)=6.205,P=0.013),and DMFSR were 9.5%and 0(Log-rankχ^(2)=4.346,P=0.037),respectively.Multivariate analysis showed that AST/ALT>1.26,tumor unresponsiveness and IMRT alone were independent risk factors for OS(all P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Compared with IMRT alone,IMRT concurrent with sorafenib can improve the long-term efficacy of HCC patients with PVTT,without increasing adverse reactions.The patients with AST/ALT<1.26,tumor response and concurrent with sorafenib have better prognosis.