动脉化疗栓塞治疗老年肝细胞癌患者疗效及影响因素分析

目的评价肝动脉化疗栓塞治疗老年（年龄〉65岁）不适宜手术切除肝细胞癌患者的疗效,并分析影响其疗效的预后因素。方法回顾性分析96例采用以TACE为主的综合性介入治疗的老年肝细胞癌患者的临床治疗和随访资料。介入治疗方案为FUDR500～750mg,CDDP40～60mg、MMC20mg/EADM30～50mg＋超液化乙碘油5～20ml,其中46例采用MMC10～20mg/EADM40～60mg＋超液化乙碘油。记录患者术后并发症发生率、死亡原因,计算患者6个月、12个月、24个月、36个月、60个月生存率。选取15个变量进行单因素和多因素分析。结果（1）96例患者TACE治疗后6个月,12个月,24个月,36个月和60个月的总体生存率分别为91.7%、71.9%、38.2%、30.5%、23.8%,中位生存时间为19个月;（2）单因素分析显示有意义的预后因素为肝功能分级、临床分期、肿瘤个数、肿瘤最大径、门静脉癌栓、动静脉瘘、肿瘤缩小程度、有无转移、有无合并症;（3）多因素分析显示有意义的预后因素为肿瘤个数、肿瘤最大径、门静脉癌栓、动静脉瘘、有无合并症。结论除肿瘤因素、肝功能状况等影响老年肝癌患者TACE治疗长期生存率外,合并症亦是影响患者生存率的关键因素。有效预防和治疗合并症可进一步提高老年肝癌患者TACE长期疗效。

Clinical Effect and Analysis of Prognostic Factors of the Elder Patients with Hepatocellular carcinoma Treated by Transcatheter Arterial Chemoembolization

Objective To evaluate the clinical effect and analyze the major prognostic factors of transcatheter arterial chemoembolization（TACE） to the elder patients （elder than 65 years）with unresectable hepatocellular carcinoma （HCC）.Materials and Methods 96 patients with HCCs elder than 65 years treated with TACE were studied retrospectively. The clinical data, therapeutic protocols and follow-up after TACE were analyzed. TACE procotol was FUDR 500-750mg, CDDP 40-60mg, Lipiodl 5-20ml mixed with MMC20mg/EADM 30-50mg, and only Lipiodl mixed with MMC20mg/ EADM 30-50mg for embolization was used in 46 patients. The rate of complication, the cause of death were recorded. Cumulative survival rates were calculated with the Kaplan-Meier method. Univariable analysis and multivariate Cox proportional hazard regression model were used to analyze the factors affecting the prognosis. Results （1） The overall cumulative survival rates for 6,12,24, 36,and 60 months were 91.7%, 71.9%, 38.2%, 30.5% and 23.8% respectively and the median survival time was 19 months. （2） Univariate analysis showed that Child grade of liver function, clinical stage, tumor number, tumor size, portal venous tumor thrombus, AVF, extrahepatic spread, tumor regression rate and concurrent disease were significant prognostic factors. （3） Multivariate analysis showed that tumor number, tumor size, portal venous tumor thrombus, AVF, concurrent disease were significant prognostic factors. Conclusion Factors of tumor and Child grade of liver function can affect the long-term survival, on the other hand, concurrent disease is also the key factor for the elder HCC patients. To prevent and manage the concurrent disease effectively can prolong the survival time and improve the long-term prognosis.