减量肝动脉化疗栓塞治疗伴有门脉癌栓的原发性肝癌的安全性和疗效

目的:研究减量肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)对伴有门脉癌栓肝癌治疗的安全性和疗效。方法:分析复旦大学附属中山医院肝癌研究所行减量TACE治疗伴门脉主干(含一级分支)癌栓的37例原发性肝癌的临床资料。Child A级34例,B级3例。37例共行TACE 75次。结果:37例患者的中位生存期为11．67个月。6个月、12个月和18个月的生存率为75．01％、41．03％和17．61％。门脉癌栓内碘油沉积良好组14例,沉积不良组23例。碘油沉积良好组的中位生存期显著优于沉积不良组为(16．23个月与6．80个月,P<0．05)。碘油沉积良好组的6个月、12个月和18个月的生存率显著高于沉积不良组(分别为100％、63．49％、31．75％和60．29％、13．03％、0％,P<0．05)。多因素分析提示门脉癌栓内碘油沉积情况是唯一的预后因素。Cox回归系数1．67,RR 5．31。术后发生上消化道出血1例,肝功能衰竭症1例, (治疗后2周内死亡),2例治疗后肝功能Child分级增加。结论:减量TACE治疗伴门脉主干癌栓的肝癌是安全有效的。门脉癌栓内碘油沉积良好提示预后好。

Feasibility and Efficacy of Dose-reduced Transcatheter Arterial Chemoembolization (TACE) for Primary Liver Cancer Patients with Portal Vein Thrombosis

Objective:To evaluate the efficacy and safety of does-reduced transcatheter arterial chemoembolization (TACE) for primary liver cancer patients with major portal vein thrombosis. Methods: 37 patients with major portal vein and/or its first branch thrombosis underwent does-reduced TACE were retrospectively analyzed. The Child's scale were A for 34 patients and B for 3. Results: 14 patients achieved good precipitation of lipiodol in the portal vein thrombosis, the other 23 patients with poor precipitation of lipiodol in the portal vein thrombosis. The overall median survival time was 11. 67 months. The cumulative survival rates were 75.01 % (6 months), 41.03% (12 months), and 17.61% (18 months). There were14 patients achieved well precipitation of lipiodol in the portal vein thrombosis and the other 23 with poor lipiodol precipitation. For patients with well precipitation of lipiodol, the median survival time was significantly longer than patients with poor lipiodol precipitation (16. 23 VS 6. 80 months, P<0. 05). The 6m, 12m and 18m survival rate of patients with well lipiodol precipitation was significantly better than that of with poor lipiodol precipitation (100%, 63. 49% ,31. 75% VS 60. 29% ,13. 03% ,0% ,P<0. 05). Cox multi-variable analysis shows that the extent of lipiodol precipitation was the only significant predicting factor for efficacy of therapy (Cox regressive coefficient 1. 67,RR5. 31). All the patients were safely tolerated with dose-reduced chemoembolization except 1 died of liver failure 2 weeks after the procedure, 1 case of upper gastrointestinalt bleeding, the other 2 with increased Child-pugh scale. Conclusion:Dose-reduced chemoembolization for primary liver cancer patients with major portal vein thrombosis is safe, and can partially achieve curative effect especially for patients with good precipitation of lipiodol in the portal vein thrombosis.