31例肝癌脑转移患者的临床特点及预后影响因素  

Brain metastases from hepatocellular carcinoma：clinical features and prognostic factors in 31 cases

作　　者：张瑞丽[1] 张华[1] 张仑[1] 肖蕾[1] 孙岩娜[1] 杨颖[1] 包永星[1] 

机构地区：[1]新疆医科大学第一附属医院肿瘤中心,乌鲁木齐830054

出　　处：《中华肿瘤杂志》2016年第4期305-309,共5页Chinese Journal of Oncology

摘　　要：目的：探讨肝癌脑转移患者的临床特点和预后影响因素。方法回顾性分析31例肝癌脑转移患者的临床资料，对预后影响影响因素进行单因素和多因素生存分析。结果31例肝癌患者诊断为脑转移，肝癌脑转移的发生率为0．61％。诊断肝癌脑转移时患者的平均年龄为48．5岁，其中男性患者26例。从诊断肝癌到脑转移的平均时间间隔为14个月，肝癌脑转移患者的中位生存时间为10周。单因素分析显示，脑部放疗、颅内转移瘤数目、卡氏评分、独立递归分级指数（ RPA）分级和Child-pugh分级与患者的预后均有关（均P＜0．05）。 Cox多因素分析显示，RPA分级和脑部放疗为影响患者预后的独立因素（均P＜0．05）。结论肝癌脑转移患者生存时间短，预后差。但对于RPA分级低的患者，积极地进行脑部放疗可延长患者的生存时间。Objective Brain metastases （ BM） from hepatocellular carcinoma （ HCC） are rare and are associated with a poor prognosis. The aim of this study was to analyze the clinical features and evaluate the prognostic factors of brain metastases from hepatocellular carcinoma. Methods The clinical data of thirty-one patients with HCC and BM treated in the First Affiliated Hospital of Xinjiang Medical University between January 1998 and December 2013 were retrospectively reviewed. Univariate and multivariate survival analyses were performed to identify possible prognostic factors. Results Thrity-one patients were diagnosed with BM from HCC, an incidence rate of 0.61%. The median age at diagnosis of brain metastases was 48.5 years. Twenty-six patients were male. The median interval from diagnosis of hepatocellular carcinoma to brain metastases was 14 months. The median survival after the diagnosis of BM was 10 weeks. Univariate analysis showed that treatment modality, number of brain lesions, Karnofsky performance score, recursive partitioning analysis （RPA） class, and Child-Pugh classification had a statistically significant impact on the survival. The multivariate analysis showed that the low RPA class and aggressive brain radiotherapy were positively associated with improved survival. Conclusion BM from HCC is rare and associated with an extremely poor prognosis. However, patients with a low RPA class may benefit from aggressive brain radiotherapy.

关 键 词：肝肿瘤 放射疗法 计算机辅助 预后 脑转移 

分 类 号：R735.7[医药卫生—肿瘤]