肝细胞癌骨转移的临床特征及预后因素

目的 分析原发性肝细胞癌(以下简称肝癌)骨转移患者的临床特征及预后因素,以期为临床制定合适的放疗策略提供依据.方法 收集接受外照射治疗的肝癌骨转移患者205例,对其一般资料、实验室指标、肿瘤特性(原发灶及骨转移灶)及治疗措施进行回顾性分析.放射剂量范围为32 ～ 60 Gy,中位剂量50 Gy,照射区为骨转移灶区域.用Kaplan-Meier法进行生存分析,单因素分析用Log-rank方法,多因素分析采用Cox回归模型Backward-Wald法.结果 205例肝癌骨转移患者中位生存时间为7.4月,有80例(39.0％)骨转移灶周围伴有软组织肿块.发现在照射剂量32 -66 Gy范围内,其剂量与效应之间并不呈正相关.单因素分析发现较短的生存率和以下几方面有关:较低的Karnofsky评分、白蛋白水平,较高的骨转移时ALP水平、γ-GT水平、AFP水平、肝内肿瘤＞5 cm、肝内原发灶未控、多发骨转移灶等.多因素分析发现,较低的Kamofsky评分、骨转移时较高的AFP水平、AST水平、血小板计数、肝内原发灶未控制、前5年的治疗诸因素均为独立预后因子(P值均＜0.05).结论 本研究提供了有关肝癌骨转移患者的临床特征、生存结果、预后因素,这些预后因素将有助于制定合适的针对这类患者的放疗策略.

Clinical characteristics and prognostic factor analysis of bone metastases from hepatocellular carcinoma

Objective To evaluate the clinical characteristics and prognostic factors analysis of patients with bone metastases （BM） from hepatocellular carcinoma （HCC）. Methods 205 patients with BM from HCC received external-beam radiotherapy （EBRT） were enrolled. Demographic variables, laboratory values ,tumor characteristics（ intrahepatic primary tumors and bone metastatic sites） and treatment forms received before EBRT were retrospectively analyzed. The total radiation dose ranged from 32 to 60 Gy, the median dose was 50 Gy, radiation field was bone metastases areas. Survival time was calculated by Kaplan-Meier curves, univariate analysis by Log-rank method, and multivariate analysis by Cox proportional hazards regression and Backward-Wald method. Results Among 205 patients with BM from HCC, 80 patients showed expansile soft-tissue masses. Median survival was 7.4 months. There was no consistent dose-response relationship for palliation of BM with dose 32 - 66 Gy. Via univariate analyse, shorter survival was relevanted with the following several aspects ： poorer performance status, lower albumin levels, higher alkaline phosphatase, ~/-glutamyhransferase, c~-fetoprotein levels ,tumer size 〉 5 cm, uncontrolled intrahepatic tumorsand muhifocal bone lesions, etc. On multivariate analysis, poorer performance status, higher ct-fetoprotein with BM, higher aspartate aminotransferase, higher platelet count, uncontrolled intrahepatic tumors,treaments received in the past 5 years and so on were independent unfavorable prognostic factors. Conclusions This study provides imformations about clinical characteristics, survival outcomes, prognostic factors for HCC with BM in a relatively large cohort of patients received EBRT. These prognostic factors will help us to make right RT strategy for these patients.