姑息性放疗剂量不是肝细胞癌合并门静脉癌栓患者的预后因素

目的研究原发性肝细胞肝癌伴门静脉癌栓接受外放疗患者的疗效和预后因素。方法回顾性分析2000年1月至2009年11月期间在复旦大学附属中山医院放疗科进行外放射治疗的126例原发性肝细胞肝癌伴门静脉癌栓患者的临床资料。采用6MX或15MV光子,针对癌栓(部分包括肝内肿瘤)外照射,剂量30～60 Gy,中位剂量50 Gy,常规分割。生存分析采用单因素及COX回归多因素分析。结果多因素分析显示白蛋白水平、AFP、肝功能Child-Pugh分级、肝内肿瘤控制情况、淋巴结转移情况和放疗方法是独立的预后因素。放疗剂量与生存无显著性相关。结论在肝细胞肝癌患者中,外放疗治疗门静脉癌栓是安全而有效的。但是,姑息性放疗剂量不是肝细胞肝癌合并门静脉癌栓患者的预后因素。

The Dose of Palliative External-Beam Radiation Do Not Influence The Survival of Patients in Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombus

Objective To evaluate the effectiveness and prognosis of patients in advanced hepatocellular carcinoma(HCC) with portal vein(PV) tumor thrombus received external-beam radiation therapy(EBRT).Methods The clinical data of 126 HCC patients with PV tumor thrombus who were referred for EBRT at our institution from January 2000 to November 2009 were analyzed retrospectively.EBRT was designed to focus on the tumor thrombus with or without primary intrahepatic tumors,to deliver a median total conventional dose of 50 Gy(range of 30-60 Gy).Predictors of survival were identified using univariate and multivariate analysis.Results Unfavorable pretreatment predictors were associated by multivariate analysis with lower albumin and higher α-fetoprotein levels,poorer Child-Pugh liver function classification,poorer intrahepatic tumor control,lymph node metastases,and the two-dimensional EBRT technique.The dose of EBRT showed no significant in both univariate and multivariate survival analysis.Conclusions In patients with HCC,EBRT is effectively prevents progression in cases of PV tumor thrombus,but palliative dose of EBRT is not related to survival.