经肝动脉化疗栓塞联合射频消融治疗原发性肝细胞癌合并门静脉癌栓的预后影响因素分析

背景与目的：经肝动脉化疗栓塞（transcatheter arterial chemoembolization，TACE)是否为治疗原发性肝细胞癌（hepatocellular carcinoma，HCC）合并门静脉癌栓（portal vein tumor thrombus，PVTT）的绝对禁忌，目前尚无定论。该研究旨在探讨TACE联合射频消融（radiofrequency ablation，RFA）治疗HCC合并PVTT的预后影响因素。方法：回顾性分析2011年1月1日—2013年12月31日于郑州大学附属肿瘤医院行TACE联合RFA治疗的HCC合并PVTT的157例患者的临床资料及随访数据，单因素及多因素Cox回归分析人口学资料、实验室指标及临床资料与生存时间和肿瘤转移复发情况的关系。结果：多因素Cox回归结果显示，在调整和控制其他因素后，血清白蛋白（albumin，ALB）水平为TACE联合RFA治疗后HCC合并PVTT患者3年生存及降低肿瘤复发转移风险的保护性因素，术前甲胎蛋白（alpha-fetoprotein，AFP）、丙氨酸转氨酶（alanine aminotransferase，ALT）、天门冬氨酸转氨酶（aspartate transaminase，AST）水平、门静脉癌栓部位及肝功能Child Pugh分级为患者3年生存的独立危险因素；AFP、AST水平及门静脉癌栓部位为肿瘤复发转移的独立危险因素。结论：TACE联合RFA并非治疗HCC合并PVTT的绝对禁忌，在治疗前对患者进行相关因素评估有助于更好地选择治疗方法和时机，从而提高HCC治疗水平。

Investigation of prognostic factors of primary hepatocellular carcinoma with portal vein tumor thrombus after transcatheter arterial chemoembolization combined with radiofrequency ablation

Background and purpose: There is still no definite conclusion whether transcatheter arterial chemoembolization (TACE) is an absolute contraindication to the treatment for primary hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Aim of the current study was to investigate the prognostic factors of HCC with PVTT treated by TACE combined with radiofrequency ablation (RFA). Methods: We retrospectively analyzed the medical records and follow-up data of 157 patients who underwent TACE combined with RFA in the Affiliated Tumor Hospital of Zhengzhou University from January 1, 2011 to December 31, 2013. The relationships between demographic data, serological markers, clinical data and 3-year survival rate, tumor metastasis and recurrence were analyzed by univariate and multivariate Cox regression analysis. Results: Multivariate Cox regression analysis showed that higher serum albumin (ALB) level was the protective factor for the survival of patients with HCC and PTVV after TACE combined with RFA treatment and reduced the risk of tumor recurrence and metastasis after adjustment and control of other factors. High levels of alpha-fetoprotein (AFP), alanine aminotransferase (ALT) and aspartate transaminase (AST), portal vein trunk suppositories and mixed tumor thrombus, and higher stage of the Child Pugh classification were independent risk factors of 3-year survival. High levels of AFP and AST, portal vein trunk suppositories and mixed tumor thrombus were independent risk factors of tumor recurrence and metastasis. Conclusion: TACE combined with RFA is not an absolute contraindication for the treatment of HCC with PVTT, the prognosis affected by a variety of factors. Evaluating the relevant factors of each patient before treatment may be helpful in choosing the better indications and assessing the possible prognosis to improve HCC treatment.