肝细胞肝癌脑转移临床特性和预后分析

目的：分析肝细胞肝癌（hepatocellular carcinoma，HCC）脑转移的临床特点和预后相关因素。方法：回顾性研究2004—0430—2011-12-01我院在放疗科诊治的32例HCC脑转移患者，其中27例接受脑部肿瘤的放射治疗，随访患者的生存情况。结果：32例患者中，27例患者出现中枢神经系统症状，5例无症状即发现颅脑转移。脑转移到死亡的中位生存期为（4．53±2．12）个月，颅脑HCC后到脑转移的中位时间为14．5个月，1年生存率为15．6％。单因素分析显示，颅脑症状（P=0．008）、RPA（P=0．002）、Child-Pugh肝功能分级（P〈0．01）及肝内病灶控制情况（P=0．040）与生存时间相关；多因素分析则显示，颅脑症状、颅内转移灶数目（P=0．027）和是否接受过脑转移灶放疗（P=0．001）是影响患者预后的主要因素。20例脑转移患者已经出现肺转移，21例患者死于肝内病灶未控，5例患者因脑转移灶未能控制而死亡。结论：HCC脑转移患者生存时间短，大部分患者以伴有颅外转移灶，颅内症状、肝功能分级、颅内病灶个数和是否放疗是预后主要因素。

Clinical features and prognosis of patients with brain metastasis from hepatocellular carcinoma

OBJECTIVE： To analyse the clinical characteristics and prognosis for hepatocellular carcinoma patients with brain metastasis. METHODS： Retrospective analysis was carried out in 32 cases of hepatocellular carcinoma with brain metastasis within nearly 8 years in department of radiation oncology,27 cases underwent brain tumor radiotherapy. All patients survival condition was followed up. RESULTS： In 32 patients 27cases showed central nervous system symp- toms. The median survival time was 4.5 months. The median time from diagnosis of hepatic cell carcinoma to the brain metastasis was 14：. 5 months, and one year survival was 15.6 %. Through single factor analysis method, the central nervous system symptoms （P=-0. 008） ,RPA （P=0. 002） and Child-Pugh liver function （P〈0.01） were prognostic factors. Mul- tivariate analysis showed that,in addition to the central nervous system symptoms, the number of intracranial metastases （P=-0. 027）, whether they had received focal radiotherapy （P= 0. 001） also affected the prognosis of these patients. Twenty patients had pulmonary metastases,21 patients died of liver failure induced by uncontrolled intrahepatic lesions, 5 patients died of brain metastases. CONCLUSIONS： The patients of hepatocellular carcinoma with brain metastasis have short survival time,mostly associated with previously existed extracranial metastasis. The prognosis is related to whether the liver lesion was controlled,RPA score and liver function grade.