调强放疗联合肝动脉化疗栓塞术治疗肝癌合并门静脉癌栓的疗效影响因素分析

Analysis of Influencing Factors of Intensity Modulated Radiation Therapy combined with Transcatheter Arterial Chemoembolization in the Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus

目的评估调强放疗(IMRT)联合肝动脉化疗栓塞术(TACE)在治疗肝癌(HCC)合并门静脉癌栓(PVTT)的疗效影响因素,确定联合治疗方法是否安全。方法回顾东莞市松山湖中心医院从2015年1月至2020年7月的25例HCC合并PVTT并经历IMRT联合TACE的不可手术患者,观察患者近期疗效及生存率并进行统计学分析。结果癌栓分期(程氏分型)、胆红素异常对近期疗效差异具有统计学意义(P<0.05)。单因素分析提示,癌栓分型(χ^(2)=4.519,P=0.034)、胆红素异常(χ^(2)=11.599,P=0.003)、ALT或AST升高(χ^(2)=8.144,P=0.017)对生存差异具有统计学意义。胆红素升高和ALT/AST升高是影响患者生存的独立预后因素。结论对于IMRT合并TACE治疗HCC合并PVTT的患者,治疗后具有更好的肝功能的患者疗效更好。

Objective To evaluate the influence factors of intensity modulated radiation therapy(IMRT)combined with transcatheter arterial chemoembolization(TACE)in the treatment of hepatocellular carcinoma(HCC)with portal vein tumor thrombus(PVTT),and to determine whether the combined therapy is safe.Methods A total of 25 patients with HCC complicated with PVTT and undergoing IMRT combined with TACE from January 2015 to July 2020 in Dongguan Songshanhu Central Hospital were reviewed.The short-term efficacy and survival rate were observed and statistically analyzed.Results The difference of tumor thrombus stage(Cheng's classification)and abnormal bilirubin on short-term curative effect was statistically significant(P<0.05).Univariate analysis showed that tumor thrombus type(χ^(2)=4.519,P=0.034),abnormal bilirubin(χ^(2)=11.599,P=0.003),elevated ALT or AST were statistically significant for survival(χ^(2)=8.144,P=0.017).Conclusion For patients with HCC and PVTT treated by IMRT combined with TACE,patients with better liver function after treatment have better curative effect.