原发性肝癌立体定向放疗的疗效及安全性研究

Effectiveness and Safety of Stereotactic Body Radiotherapy for Hepatocellular Carcinoma

目的:探讨立体定向放疗(stereotactic body radiotherapy, SBRT)治疗原发性肝癌的疗效、安全性及影响预后的因素。方法:回顾性分析2006年6月至2017年12月在中国航空工业三六三医院行SBRT治疗的202例原发性肝癌患者。随访患者的肿瘤控制情况、生存和不良反应。Kaplan-Meier法分析生存情况;log-rank检验和Cox比例风险回归模型分析影响生存的相关因素。结果:近期疗效评估,完全缓解(complete response, CR)29例(14.4%),部分缓解(partial response, PR)40例(19.8%),总有效率34.2%。患者6个月和1、2、3年的局部控制率分别为71.1%、50.4%、31.7%和22.0%。6个月和1、2、3、5年的生存率和无进展生存率分别为76.2%、56.4%、39.6%、30.0%、16.4%及68.6%、48.4%、30.0%、21.3%、12.6%。急性不良反应多为1~2级。32例(15.8%)患者出现3级不良反应,2例(1%)出现4级总胆红素升高。多因素分析显示KPS评分、病灶个数、肿瘤最大径之和、Child-Pugh分级和BCLC分期为影响预后的独立因素。结论:立体定向放射治疗原发性肝癌安全有效,值得进一步研究和临床推广。

Objective: The study aims to evaluate the therapeutic effectivenessof stereotactic body radiotherapy(SBRT) in patients with hepatocellular carcinoma(HCC), and factors affecting prognosis.Methods:We retrospectively analyzed 202 HCC patients treated by SBRT in AVIC 363 Hospital between June 2006 and December 2017. The patients were followed up for tumor control and adverse events after treatment. Kaplan-Meier method was used to calculate survival rates. Log-rank test and COX proportional hazards model were used to analyze the influencing factors for survival. Results:Complete response(CR) was achieved in 14.4% of the patients(29 cases), partial response(PR) in 19.8%(40 cases), with an overall response rate(CR+PR) of 34.2%. 6-month, and 1-, 2-and 3-year local control probabilitieswere 71.1%, 50.4%, 31.7% and 22.0%, respectively;6-month, and 1-, 2-, 3-and 5-year overall survival rates were 76.2%,56.4%, 39.6%, 30.0%, and 16.4%,respectively;6-month, and 1-, 2-, 3-, 5-year progression-free survival rates were 68.6%, 48.4%, 30.0%, 21.3% and 12.6%,respectively. Most of the patients experienced mild(grade 1~2) treatment-related adverse events;32(15.8%) patients experienced grade 3 adverse events;and only 2(1%) experienced grade 4. Multivariate regression analysis showed that KPS score, number of lesions, sum of maximum tumor diameter, Child-Pugh grade and BCLB stage werestrongly correlate to survival.Conclusion:SBRT is safe and effective in the treatment of hepatocellular carcinoma, which is worthy of clinical promotion.