肝细胞肝癌伴门静脉/下腔静脉癌栓接受与不接受放射治疗的比较

目的探讨肝细胞肝癌患者伴门静脉和或下腔静脉癌栓接受外放射治疗的疗效。方法回顾总结近8年180例原发性肝细胞肝癌伴门静脉和或下腔静脉癌栓患者,其中66例接受直线加速器外放疗作为放疗组,114例未接受外放疗作为对照组,放疗组与对照组间影响患者的主要预后因素除肿瘤标志物有差别外,其他因素无明显差别。放疗组放疗方法为常规分割,局部放疗癌栓,放射治疗剂量介于36～60Gy(中位50Gy)。放射治疗中及治疗后随访肝功能、影像学检查和生存情况。应用Cox回归模型,多因素分析比较两组的生存期。结果66例癌栓患者接受外放射治疗,22例(33.3%)患者癌栓完全缓解,16例(24.2%)部分缓解,26例(39.4%)稳定,2例(3.1%)进展;1年生存率27.9%,中位生存期7.3个月。对照组1年生存率为12.3%,中位生存期为4个月。多因素回归分析显示,外放射治疗显示出很强的保护因素(RR=0.408,P<0.001)。放疗组病人生存情况与甲胎蛋白水平无关;但与γ-GT水平、肝内病灶单多发、癌栓存在的部位有关。死亡原因多为肝内肿瘤未控制导致肝衰。对照组下腔静脉系统癌栓患者生存情况比门静脉癌栓患者差,相反,放疗组下腔静脉癌栓患者的生存情况好于门静脉癌栓患者。结论结合外放射治疗可明显延长肝细胞肝癌伴有门静脉和或下腔静脉癌栓患者的生存期,肝内原发肿瘤灶为单发的癌栓患者,放射治疗更能延长其生存期。

A comparison of treatment combinations with and without radiotherapy for the hepatocellular carcinoma with portal vein and/or inferior vena cava tumor thrombus

Objective We evaluated the potential role of external beam radiation therapy(EBRT)in the treatment of hepatocellular carcinoma(HCC)patients with portal vein(PV)and/or inferior vena cava(IVC)tumor thrombi.Methods[WTBZ] One hundred eighty HCC patients with PV and/or IVC tumor thrombus were reviewed and analyzed by Kaplan-Meier and Cox regression analysis.Sixty-six HCC patients who received local limited EBRT(in addition to other treatment modalities)were classified as the EBRT group.The total radiation dosage ranged from 36 to 60 Gy(median 50 Gy),focused on the tumor thrombi.One hundred and fourteen HCC patients who did not receive EBRT were selected from hospitalized HCC patients with PV and/or IVC thrombi in the same period and were classified as the non-EBRT group;the intrahepatic tumors of these patients were treated with transarterial chemoembolization(TACE)or resection based on the patients' status.Parameters observed include survival rates and the tumor thrombus response to EBRT as seen on CT scan or MRI.Results Out of the 66 patients who received EBRT,22(33.3%)showed complete disappearance of tumor thrombi,16(24.2%)were in partial remission,26(39.4%)were stable in their tumor thrombi,and 2(3.1%)patient showed disease progression at the end of the study period.The median survival was 7.3 months,and the 1-year survival rate was 27.9% in the EBRT group.In the non-EBRT group,the median survival and 1-year survival rate were 4 months and 11.4%,respectively.In stepwise multivariate analysis,EBRT showed a strongly protective value(RR=0.408,P<.001).Survival was not related to intrahepatic tumor status in the non-EBRT patients.However,in the EBRT group,poorer prognosis was significantly related to intrahepatic multifocal or diffusion lesions,and the most common reason for death was liver failure caused by the uncontrolled intrahepatic diseases.Conclusion Although EBRT is palliative in intent,it is preferred for prolonging survival in the treatment of tumor thrombi.