原发性肝癌骨转移的相关预后因素分析及放疗效果

目的观察原发性肝癌骨转移的放疗效果，探讨相关预后因素。方法对105例原发性肝癌骨转移病例进行回顾性分析，所有病例的骨转移灶均行常规放疗，中位肿瘤剂量40．0Gy。对性别、肝功能状况、原发灶大小和数目、原发灶控制情况、有无手术切除、骨转移灶数目、骨转移时AFP水平、r-GT水平及骨转移时是否伴骨旁软组织和其他脏器转移等多项因素进行分析。运用Kaplan-Meier法进行生存分析，单因素分析采用Logrank法，多因素分析采用Cox回归模型。结果原发性肝癌骨转移患者1、2、3年生存率分别为21．9％、5．6％、4．2％，中位生存期6个月。肝内原发灶控制情况、有无手术、骨转移时AFP和r-GT水平、骨转移时是否伴骨旁软组织和其他脏器转移为独立预后因子（P值均〈0．05）。其余因素与生存率无明显相关。结论原发性肝癌骨转移患者经外照射后症状明显缓解，但远期疗效仍然很差。肝内原发灶控制情况、肝内原发灶有无手术切除、骨转移时AFP和r-GT的水平、骨转移灶旁软组织转移和其他脏器转移与预后有关。

Prognostic factors and effect of radiotherapy for patients with bone metastasis from primary liver cancer

Objective To evaluate the prognosis factor and outcome of radiotherapy for patients with bone metastasis from primary liver cancer.Methods The data of 105 patients with bone metastasis from primary liver cancer treated between Oct.1996 and Aug.2004 were retrospectively analyzed.All bone metastases received radiotherapy in conventional fractions with a dose of 2?Gy/Fx,with a median of 40?Gy/20Fx.The primary lesion was treated with either surgical resection or TACE (transcatheter hepatic arterial chemoembolization).Statistical analysis was done using the Package for Social Sciences,Version 12.0.Survival rates were obtained by Kaplan-Meier method,univariate analysis by Logrank,multivariate analysis by Cox regression.Results The 1-,2-and 3-year cumulative survival rates were 21.9%,5.6%,4.2%,respectively.The control of intrahepatic lesion,resection of intrahepatic lesion,serum r-GT level and AFP level of bone metastasis,soft tissue around the bone lesions,and other distant metastasis were independent prognostic factors(P<0.05).Conclusion Even though the long-term survival is poor in liver cancer patients with bone metastasis,its bone lesion is sensitive to EBRT(external-beam radiotherapy),which results in palliative relief of pain.