肝转移瘤患者TACE术后肝脏体积变化对肝功能及预后的影响

Effect of Liver Volume Changes on Liver Function and Prognosis in Patients with Liver Metastases After TACE

目的探讨肝转移瘤患者肝动脉灌注化疗栓塞(TACE)术后肝脏体积变化对肝功能及预后的影响。方法回顾性分析86例肝转移瘤患者临床资料。所有患者均行TACE术治疗,并于术前及术后行CT检查评估肝脏体积(LV)、肿瘤体积(TV)变化;依据术后肝功能损伤情况分为2组,收集2组一般资料,开展Logistic回归分析获取影响肝转移瘤患者TACE术后肝功能损伤的独立危险因素;绘制ROC曲线分析LV在预测肝功能损伤中的临床价值;并分析肝脏体积变化与预后关系。结果86例肝转移瘤患者,TACE术后出现19例肝功能损伤,损伤率为22.09%(19/86);肝损伤组术后LV小于未损伤组,TV大于未损伤组,差异有统计学意义(P<0.05);绘制ROC曲线显示,术后LV、TV预测肝转移瘤患者TACE术后肝功能损伤的曲线下面积分别为0.916、0.603,LV预测价值更高。多因素分析显示,△LV分级、术前Child-Pugh分级为肝转移瘤患者TACE术后肝功能损伤的独立影响因素(P<0.05且OR>1)。所有患者中位生存时间为15个月,△LV1级患者中位生存时间17个月,△LV2级患者中位生存时间12个月;随访结束,△LV1级患者生存率为78.95%(45/57),△LV2级患者生存率为51.72%(15/29),差异有统计学意义(χ^(2)=6.754,P=0.009)。结论肝转移瘤患者TACE术后肝脏体积可发生一定变化,通过CT检测LV能够较好地预测肝功能损伤情况,并有助于评估患者预后。

Objective To investigate the influence of liver volume changes on liver function and prognosis in patients with liver metastases after transcatheter arterial chemoembolization(TACE).Methods The clinical data of 86 patients with liver metastases were analyzed retrospectively.All patients were treated with TACE,and the residual liver volume(LV)and tumor volume(TV)were evaluated by CT before and after the operation;The patients were divided into 2 groups according to the situation of liver function injury after TACE.The general data of the 2 groups were collected,and the independent risk factors of liver function injury after TACE were obtained through Logistic regression analysis;Draw ROC curve to analyze the clinical value of LV in predicting liver function injury;The relationship between liver volume change and prognosis was analyzed.Results Among 86 patients with liver metastasis,19 patients had liver function injury after TACE,the injury rate was 22.09%(19/86);The LV in the liver injury group was lower than that in the non injury group,and the TV was higher than that in the non injury group(P<0.05);The ROC curve showed that the area under the curve of LV and TV predicting liver function damage after TACE was 0.916 and 0.603,respectively.LV had a higher predictive value;Multivariate analysis showed that△LV grade and preoperative Child Pugh grade were independent influencing factors for liver function damage in patients with liver metastases after TACE(P<0.05 and OR>1);The median survival time of all patients was 15 months,the median survival time of△LV1 patients was 17 months,and the median survival time of△LV2 patients was 12 months;At the end of follow-up,the survival rate of△LV1 patients was 78.95%(45/57),and that of△LV2 patients was 51.72%(15/29);The survival rate of patients with△LV1 was higher than that of patients with△LV2,and the difference was statistically significant(χ^(2)=6.754,P=0.009).Conclusion The liver volume of patients with liver metastases after TACE can change to some extent.The detection of LV by CT can better predict the liver function damage and help to evaluate the prognosis of patients,which is worthy of clinical attention.