减量化疗肝动脉栓塞治疗肝癌合并白细胞和（或）血小板减少的研究

目的研究减量化疗肝动脉栓塞对伴有白细胞和（或）血小板减少的原发性肝癌治疗的安全性及有效性。方法回顾性分析292例行减量化疗肝动脉栓塞治疗的原发性肝癌病例。所有病例伴有白细胞≤3.0×10^9/L和（或）血小板≤50×10^9/L。全组292例分成3组,A组伴有白细胞减少85例;B组伴有血小板减少41例;C组同时伴有白细胞和血小板减少166例。结果全组中位生存期23.0月,1年生存率72.2%;A、B和C组中位生存期分别为26.0月、36.0月和20.0月,1年生存率分别为73.6%、87.5%和69.5%。对292例患者作单因素及多因素生存分析显示,白细胞≤2.0×10^9/L（r=0.657,P=0.016）、肿瘤〉5 cm（r=3.175,P=0.000）和白蛋白≤35 g/L（r=0.452,P=0.000）是生存时间的独立影响因素,血小板计数不是生存的影响因素。60例（20.5%）患者在介入治疗术前和（或）术后使用重组人粒细胞集落刺激因子（granulocyte colony stimulating factor,G-CSF）,用药与否对生存没有影响。介入术后1月内随访白细胞与血小板均无明显下降,所有患者无严重骨髓抑制发生。结论减量化疗肝动脉栓塞治疗伴有白细胞和（或）血小板减少的原发性肝癌是安全有效的。

Dose-reduced TACE for primary liver cancer patients with leukocytopenia and /or thrombocytopenia

Objective To evaluate the safety and efficacy of dose-reduced transarterial chemoembolization（ TACE）for primary liver cancer patients with leukocytopenia and /or thrombocytopenia. Methods The clinical data of 292 primary liver cancer patients with white blood cell count（ WBC） ≤3. 0 × 10^9/L and /or blood platelet count（ BPC） ≤50 × 10^9/L undergoing dose-reduced TACE were retrospectively analyzed. The patients were divided into 3 groups： group A with WBC≤3. 0 ×10^9/L（ n = 85）,group B with BPC≤50 × 10^9/L（ n = 41） and group C with WBC≤3. 0 × 10^9/L and BPC≤50 ×10^9/L（ n = 166）. Results The median overall survival time and 1-year cumulative survival rate were 23. 0 months and72. 2%. The median overall survival time and 1-year survival rates for groups A,B and C were 26. 0 months and 73. 6%,36. 0 months and 87. 5%,20. 0 months and 69. 5%,respectively. Univariate and multivariate analysis showed that WBC≤2. 0 × 10^9/L（ r = 0. 657,P = 0. 016）,tumor size 5 cm（ r = 3. 175,P = 0. 000） and albumen（ ALB） ≤35 g /L（ r = 0. 452,P= 0. 000） were independent predicting factors for overall survival,but BPC was not（ P〉 0. 05）. Sixty（ 20. 5%） patients received recombinant human granulocyte colony stimulating factor（ G-CSF） pre- and /or post-intervention,but the application of G-CSF had no significant impact on survival. There was no severe myelosuppression observed and no decreased WBC and BPC one month after TACE. Conclusion Dose-reduced TACE for primary liver cancer patients with leukocytopenia and /or thrombocytopenia is safe and effective.