三维适形放射治疗原发性肝癌患者发生放射性肝损伤相关因素分析*

目的 研究三维适形放射治疗原发性肝癌患者发生放射性肝损伤（RILD)的相关危险因素。方法 对2009年3月至2015年12月期间收治的三维适形放射治疗的原发性肝癌患者的临床资料进行归纳整理,以假设检验筛选相关危险因素,并进行多因素非条件Logistic回归分析。结果 本组纳入研究的原发性肝癌患者39例,在完成放射治疗后发生RILD 14例（35.9%);各类别单因素的假设检验提示肝癌患者的年龄和肝功能CTP评分与放疗后RILD的发生相关（P<0.05）;进一步的非条件多因素Logistic回归分析显示,年龄≥60岁（OR:15.72,P=0.020）和肝功能CTP评分≥6（OR:24.95,P=0.005）是三维适形放射治疗原发性肝癌后发生RILD的2个独立危险因素。结论 通过对三维适形放射治疗原发性肝癌患者发生RILD的研究,初步识别了肝癌患者接受放疗后发生RILD的相关危险因素,为日后制定治疗计划时减少RILD的发生,或建立适当的干预措施提供了科学依据。

Risk factors for predicting radiation-induced liver disease after three-dimensional conformal radiotherapy for patients with hepatocellular carcinoma

Objective This study was aimed to investigate the possible clinical factors contributing to the development of radiation-induced liver disease（RILD） in patients with hepatocellular carcinoma receiving three-dimensional conformal radiotherapy. Methods Between March 2009 and December 2015,we included 39 patients with hepatocellular carcinoma who received three-dimensional conformal radiotherapy. Clinical data,including gender,age,other treatments,liver function test Results,and three-dimensional conformal radiotherapy parameters were retrieved for analysis. Multivariate non-conditional Logistic regression analysis was used to identify the predictors of RILD. Results Out of 39 patients with hepatocellular carcinoma,fourteen（35.9%） developed RILD after three-dimensional conformal radiotherapy;The unconditional multivariate Logistic analysis showed that the pretreatment Child-Turcotte-Pugh score ≥6 [odds ratio （OR）:24.95,P=0.005] and age ≥60 years （OR:15.72,P= 0.020） were independent risk factors for the development of RILD. Conclusion The occurrence of RILD must be taken into consideration when the three-dimensional conformal radiotherapy is applied to the patients with hepatocellular carcinoma,and the primary identification of the risk factors for RILD is important.