肝转移癌患者3D后程放疗长期随访及相关危险因素研究  

Long-term follow up and related risk factors analysis in patients with boost radiotherapy in the management of liver metastases

作　　者：鹿凯[1] 杨雪峰[1] 孙红梅[1] 尤庆山[2] Lu Kai;Yang Xnefeng;Sun Hongmei;You Qingshan(Department of Surgery,Daqing Oil General Hospital,Daqing 163001,China)

机构地区：[1]大庆油田总医院普外四科,黑龙江省163001 [2]哈尔滨医科大学附属三院放疗科,黑龙江省163001

出　　处：《中华普通外科杂志》2018年第8期678-681,共4页Chinese Journal of General Surgery

摘　　要：目的回顾性分析肝转移癌精确放疗的效果及临床预后因素。方法2010年1月至2016年1月哈尔滨医科大学附属三院收治肝转移癌患者120例（所有患者均为不适合手术治疗的初次治疗）给以后程放疗治疗。患者生存率计算采用Kaplan-Meier方法，预后因素的单因素分析，采用Log-rank进行比较患者的生存率与中位生存时间，采用Cox回归分析法进行多因素分析。结果经过放疗患者1、2、3年生存率分别为74．4％，20．2％，13．5％，中位生存期19个月。单因素分析显示，肝外转移器官数少、肝转移灶数目少、肝转移最大直径小、放疗剂量高、人院前未经化疗和卡氏评分≥80分患者的1、2、3年生存率和中位生存时间均显著提高（P〈0．05）。多因素分析显示，肝外转移器官数目、肝转移灶最大直径、转移灶数目和放疗剂量是影响肝转移癌患者生存的独立危险因素（P〈0．05）。结论肝转移癌患者采用三维适形后程补充照射技术有较高的局部控制率和1、2、3年生存率．而且正常肝组织的副损伤发牛率也比较低。Objective To evaluate the clinical effect and prognostic factors of patients with liver metastases treated with three dimensional eonformal radiation therapy （3-DCRT） with boost radiotherapy. Methods From Jan 2010 to Jan 2016, 120 patients of liver metastases treated in the Third Rradiotherapy Department of the Third Affiliated Hospital of Harbin Medical University （ all patients were treated for the first time and were not suitable for surgical treatment） were restrospeetively analyzed. Results 1, 2, 3 -year survival rates were 74. 7% , 20. 2, 13.5% , median survival was 19 months. For univariate analysis, those with less number of extrahepatic organ metastasis, fewer liver metastases, smaller size of liver metastases, higher radiation dose, no chemotherapy before radiation and Karnofsky score ≥80 points were with higher 1 -, 2 - and 3-year survival rate and longer median survival time （ P 〈 0. 05 ）. Multivariate analysis showed that the number of involved extrahepatic organs, the maximum diameter of liver metastases, numbers of metastases and radiation dose are independent factors to affect the survival of patients with liver metastases （ P 〈 0. 05 ）. Conclusions Patients with liver metastases treated with 3D-CRT and boost radiotherapy have satisfactory local control and 1,2,3-year survival rate as well as lower incidence of toxicity damage to the liver.

关 键 词：肝肿瘤 肿瘤转移 化放疗 存活率 

分 类 号：R735.7[医药卫生—肿瘤]