经肝动脉化疗栓塞术治疗肝细胞癌合并门静脉癌栓的预后影响因素分析

目的评估肝细胞癌(HCC)合并门静脉癌栓患者经肝动脉化疗栓塞术(TACE)治疗后的效果及影响预后的因素。方法回顾性分析2006年1月-2010年12月第四军医大学西京医院收治的152例行TACE治疗的HCC合并门静脉癌栓患者的临床资料。观察TACE术后肝衰竭、上消化道大出血、栓塞后综合征等发生情况,分析生存期资料与影响预后的因素。Kaplan-Meier法计算累积生存率,采用Log-Rank法进行单因素分析,Cox比例风险模型进行多因素分析。结果患者中位生存时间为5.0(95%可信区间:4.4~5.6)个月,6、12、18个月的累积生存率分别为37%、18%和9%。单因素分析显示肿瘤大小、肿瘤类型、肝两叶累及、远处转移和Child-Pugh分级是HCC合并门静脉癌栓患者行TACE治疗预后的影响因素(χ2值分别为5.108、11.542、6.036、12.319、22.574,P值均0.05);多因素分析显示肿瘤大小、肿瘤类型、远处转移和Child-Pugh分级是影响患者预后的独立危险因素(Wald值分别为11.243、5.021、7.651、25.876,P值均0.05);而HCC合并门静脉癌栓患者发生肝衰竭的唯一影响因素是Child-Pugh分级(P=0.015)。结论在肝功能良好的HCC合并门静脉癌栓患者中,TACE是安全有效的。肿瘤大小、肿瘤类型、远处转移、Child-Pugh分级是影响患者生存的最主要因素,为临床医生选择合适的介入治疗患者提供了有力证据。

Prognostic factors for transcatheter arterial chemoembolization in patients with hepatocellular carcinoma complicated by portal vein tumor thrombus

Objective Toinvestigatethetherapeuticeffectoftranscatheterarterialchemoembolization(TACE)inpatientswithhepatocellu-larcarcinoma(HCC)complicatedbyportalveintumorthrombus,andtoidentifyrelatedprognosticfactors.Methods Theclinicaldataof 152 HCC patients with portal vein tumor thrombus who were admitted to Xijing Hospital of Fourth Military Medical University and received TACE from January 2006 to December 2010 were analyzed retrospectively.The occurrence of post-TACE liver failure,upper gastrointesti-nal bleeding,and post-embolization syndrome was observed,and survival data and prognostic factors were analyzed.The Kaplan-Meier method was used to calculate cumulative survival rate,the log-rank test was used for univariate analysis,and the Cox proportional hazards modelwasusedformultivariateanalysis.Results Themediansurvivaltimewas5.0months,andthe6-,12-,and18-monthcumula-tive survival rates were 37%,18%,and 9%,respectively.Univariate analysis showed that tumor size,tumor type,involvement of both liv-er lobes,distant metastasis,and Child-Pugh class were the prognostic factors for TACE in HCC patients with portal vein tumor thrombus (χ2 =5.108,11.542,6.036,12.319,and 22.574,respectively,all P<0.05);multivariate analysis showed that tumor size,tumor type,distant metastasis,and Child -Pugh class were the independent prognostic factors (Wald values =11.243,5.021,7.651,and 25.876,respectively,all P<0.05);Child-Pugh class was the only influencing factor for liver failure in HCC patients with portal vein tumorthrombus(P=0.015).Conclusion TACEissafeandeffectiveinHCCpatientswithportalveinthrombusandgoodliverfunction. Tumor size,tumor type,distant metastasis,and Child-Pugh class are the main factors influencing survival,which provides a basis for clini-cians to select appropriate interventional therapies.