肝癌合并门静脉癌栓术前放疗疗效评价  

Evaluation of clinical efficacy of preoperative radiotherapy for hepatocellular carcinoma with portal vein tumor thrombus

作　　者：冯爽[1] 李铁华 孙居仙[1] 徐胜[1] 李晶[1] 陆艳[1] 孟岩[1] Feng Shuang;Li Tiehua;Sun Juxian;Xu Sheng;Li Jing;Lu Yan;Meng Yan(Department of Radiotherapy,Eastern Hepatobiliary Surgery Hospital,Second Military Medical University,Shanghai 200438,China)

机构地区：[1]第二军医大学东方肝胆外科医院放射治疗科,上海200438

出　　处：《中华肝脏外科手术学电子杂志》2019年第3期238-241,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：上海市卫计委科研课题面上项目(201740249)

摘　　要：目的探讨术前放疗对原发性肝癌(肝癌)伴门静脉癌栓的疗效及其应用价值。方法回顾性分析2014年1月至2017年12月东方肝胆外科医院收治的248例肝癌合并门静脉癌栓患者临床资料。其中男189例,女59例;年龄32～82岁,中位年龄53岁。患者均签署知情同意书,符合医学伦理学规定。根据治疗方法不同患者分为术前放疗+手术组(术前放疗组,102例)和单纯放疗组(146例)。观察放疗效果和不良反应。生存分析采用非参数法Wilcoxon检验。结果多数患者放疗期间有不同程度的消化道反应,表现为恶心、呕吐、纳差、腹胀等,未见上消化道出血及严重呕吐,均经对症治疗后缓解。患者均未发生严重的肝损害。通过术前18 Gy剂量放疗,最终41%(102/248)患者获得手术机会。放疗后肿瘤大面积坏死,门静脉癌栓局限、硬化、纤维化。术前放疗组1年生存率为49%,明显高于单纯放疗组的32%(Z=44.804,P<0.05)。结论术前放疗可使部分肝癌合并门静脉癌栓患者降期,获得手术切除机会,明显改善患者预后,延长总体生存时间。Objective To evaluate the clinical efficacy and application value of preoperative radiotherapy for primary liver cancer (PLC) complicated with portal vein tumor thrombus. Methods Clinical data of 248 patients with PLC complicated with portal vein tumor thrombus admitted to Eastern Hepatobiliary Surgery Hospital from January 2014 to December 2017 were retrospectively analyzed. Among them, 189 patients were male and 59 female, aged 32-82 years with a median age of 53 years. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were divided into preoperative radiotherapy + surgery group (preoperative radiotherapy group, n=102) and single radiotherapy group (n=146). The clinical efficacy and safety of radiotherapy were evaluated. Survival analysis was performed by nonparametric Wilcoxon test. Results During the period of receiving radiotherapy, most patients suffered from varying degrees of digestive tract reactions, such as nausea, vomiting, anorexia and abdominal distension, etc. No upper gastrointestinal hemorrhage or severe vomiting were observed. All symptoms were relieved after symptomatic treatments. No severe liver damage occurred in any patient. After preoperative radiotherapy at a dose of 18 Gy, 41%(102/248) of the patients obtained the opportunity of undergoing surgery. After radiotherapy, extensive tumor necrosis was observed, portal vein tumor thrombus became localized, hardened and fibrotic. In the preoperative radiotherapy group, the 1-year survival rate was 49%, significantly higher than 32% in single radiotherapy group (Z=44.804, P<0.05). Conclusions Preoperative radiotherapy can reduce the staging of liver cancer patients complicated with portal vein tumor thrombus and obtain the opportunity of surgical resection, which can significantly improve the clinical prognosis and prolongs the overall survival of patients.

关 键 词：癌 肝细胞 放射疗法 门静脉 栓塞 肿瘤细胞 循环 

分 类 号：R735.7[医药卫生—肿瘤]