肝癌并门脉主干癌栓的介入治疗及其预后的影响因素  

Interventional therapies and analysis of prognostic factors in hepatocellular carcinoma with tumor thrombus

作　　者：刘崎[1] 田建明[1] 贾雨辰[1] 王振堂[1] 叶华[1] 杨继金[1] 孙飞[1] 林琳[2] 贺佳[1] 

机构地区：[1]上海第二军医大学附属长海医院放射科,200433 [2]第二军医大学统计教研室

出　　处：《中华放射学杂志》1999年第8期538-541,共4页Chinese Journal of Radiology

摘　　要：目的　分析肝癌并门脉主干癌栓患者预后的影响因素 ,评价不同介入方法的疗效。方法　 182例肝癌并门脉主干癌栓患者行 2次以上介入治疗 ,2 6例单纯肝动脉内化学药物灌注 (化疗 )(A组 ) ,4 2例化疗加碘油栓塞 (B组 ) ,114例化疗加碘油明胶海绵栓塞 (C组 ) ,对其预后因素进行Cox回归模型分析。结果　 ( 1)单因素分析显示有意义的预后因素是Child分级、病灶类型、病灶直径、病灶占据率、有无合并动静脉瘘 (AVS)、治疗方法、治疗后肿瘤大小改变、癌栓改变及治疗次数 ;多因素分析显示Child分级、病灶占据率、有无AVS、治疗方法及治疗次数是影响预后的主要因素。 ( 2 )从治疗后肿瘤缩小、癌栓消失及生存率来看 ,C组疗效最好 ,B组次之 ,A组最差 (P <0 0 0 1)。结论　肝癌并门脉主干癌栓患者的预后与病人一般状况、肿瘤发展程度和治疗方法及时机这三者密切相关 ,对ChildA级、肿瘤相对局限者 ,积极的超选择性化疗加碘油及明胶海绵栓塞治疗有助于提高患者的生存率。Objective Tostudytheprognosticfactorsinpatientsofhepatocellularcarcinomawithtumor thrombusofmainportalvein ,andtoevaluatetheeffectofvariousinterventionaltherapy Methods onehundred andeighty twopatientswithhepatocellularcarcinomaandtumorthrombusofmainportalveinweregivenmorethan 2timesofinterventionaltreatmentviahepaticartery 2 6caseswithchemotherapyalone (groupA) ,4 2with chemoembolizationusinglipiodol (groupB) ,and 114withchemoembolizationusinglipiodolandgelfoam(group C) Coxproportionalharzardmodelwasusedtoanalysetheprognosticfactorsthatsignificantlyaffectedthesurvival period CumulativesurvivalrateswerecalculatedwiththeKaplan Meiermethod Results ( 1)Univariate analysisshowedthatChild’sclass,tumortype ,tumorsize ,tumoroccupancyrate ,hepaticarterio venousshunt (AVS) ,therapymethod ,changsoftumorsizeandtumorthrombusaftertreatment,andtreatmenttimeswere significantprognosticfactors ;multivariateanalysisshowedthatChild’sclass,tumoroccupancyrates,AVS , therapymethodandtreatmenttimeswerethemostsignificantfactors ( 2 )Thetumorsizereducedby >5 0 %was 0 forgroupA ,2 3 8%forgroupBand 3 2 5 %forgroupC Thedisappearanceratesofmainportalveintumor thrombuswere 7 7% ,2 1 4 %and 3 7 7%forgroupA ,BandCrespectively The 12 ,3 6monthsurvivalrates were 11 5 %and 0forgroupA ,2 1 4 %and 2 4 %forgroupB ,and 3 3 3 %and 3 6%forgroupC respectively Therewasobviousdifferencesamongthethreegroups (P <0 0 0 1) Conclusions Theprognosis ofhepatocellularcarcinomawithtumorthrombusofmainportalveiniscloselyrelatedwiththegeneralconditionof patient,thedegreeoftumorinvasion ,andthemanagement WhenChild’sclassisAandtumorislimitedin extent,thesuperselectivechemoembolizationusinglipiodolandgelfoamismoreeffectiveforprolongingsurvival time

关 键 词：肝癌 门脉主干癌栓 介入疗法 预后 

分 类 号：R735.705[医药卫生—肿瘤] R730.55[医药卫生—临床医学]