PVA-TACE治疗肝细胞癌并肝肺分流的临床疗效及预后分析

目的：评价聚乙烯醇微粒肝动脉化疗栓塞（PVA-TACE）治疗肝细胞癌（HCC）并肝肺分流（HPS）的临床疗效，分析影响生存预后的因素。 方法：回顾性分析42例HCC并HPS患者资料，依据分流途径分为门静脉-腔静脉分流组（A组，9例）与肝动脉-肝静脉分流组（B组，33例）。依据分流速度采用不同规格聚乙烯醇（PVA）微粒进行肝动脉化疗栓塞（TACE）治疗，随访并分析生存期及术后并发症。采用Kaplan-Meier法计算累积生存率，采用Cox模型分析生存预后的影响因素。 结果：42例患者中位生存期（OS）为9.5个月，6、12个月生存率分别为74.9%、39.4%。A组与B组中位OS分别为10.5个月、9.5个月，两组生存期无明显差异（χ²=0.410，P=0.522）。Cox回归分析结果显示：行为状态（PS）评分较高（HR=2.454，P=0.026）、肿瘤负荷>50%（HR=3.477，P=0.019）及门静脉主干癌栓形成（P=0.006）为预后的独立危险因素，而多次栓塞（HR=0.329，P=0.008）为预后的独立保护因素。 结论：经谨慎选择病例，PVA-TACE治疗HCC合并HPS安全、有效。经多次栓塞治疗患者预后较好，而PS评分较高、肿瘤负荷较大及门静脉主干癌栓形成的患者预后不良。

Polyvinyl alcohol chemoembolization for hepatocellular carcinoma with hepatopulmonary shunting: clinical efficacy and prognostic factors

Objective:To evaluate the efficacy and prognosis of polyvinyl alcohol (PVA) chemoembolization in treating hepatocellular carcinoma (HCC) with hepatopulmonary shunting (HPS). Methods:A total of 42 patients' clinical data were retrospectively analyzed. According to the shunting pathway, the patients were divided into group A (portal-systemic shunting, n=9) and group B (arterio-hepatic vein shunting, n=33). Based on shunting speed, different amount of PVA was used to embolize the shunts. The overall survival (OS) and postoperative complications, etc. were analyzed in the follow-up study. Survival prognostic factors were assessed by univariate Kaplan-Meier analysis with Log-rank test and a multivariate Cox proportional hazard model. Results:The median OS of the 42 patients was 9.5 months, and the 6-month, 12-month survival rate were 74.9% and 39.4%, respectively. The median OS of the group A and group B were 10.5 months and 9.5 months, respectively, showing no significant difference between two groups (χ²=0.410, P=0.522). Cox multivariate survival analysis revealed that higher performance status (PS) score (HR=2.454, P=0.026), tumor burden >50% (HR=3.477, P=0.019) and main portal vein invasion (P=0.006) were independent risk factors. Multiple embolization (HR=0.329, P=0.008) was an independent protection factor. Conclusion:PVA chemoembolization is a safe and effective strategy for selected HCC patients with HPS . Multiple embolization can achieve better survival prognosis in HCC with HPS patients while for those with, tumor burden >50% and main portal vein invasion it showed poor survival prognosis.