程氏分型对肝细胞癌伴门脉癌栓放疗预后的指导价值  

Radiotherapy compared with palliative care for advanced hepatocellular carcinoma with portal vein tumor thrombus: using a new classifcation

作　　者：杨柳[1] 朱曦龄 金帅 常娜 赵于飞 黎功 Yang Liu;Zhu Xiling;Jin Shuai;Chang Na;Zhao Yufei;Li Gong(Department of Radiation Oncology,Anhui Provincial Tumor Hospital,Hefei 230001,Anhui,China;Department of Oncology,The Third Medical Center of PLA General Hospital,Beijing 100039,China;Department of Radiation Oncology,Beijing Tsinghua Changgung Hospital,Beijing 102218,China)

机构地区：[1]中国科学技术大学附属第一医院西区/安徽省肿瘤医院放疗科,安徽合肥230001 [2]解放军总医院第三医学中心肿瘤二科,北京100039 [3]北京清华长庚医院放疗科,北京102218

出　　处：《肝癌电子杂志》2020年第3期7-11,共5页Electronic Journal of Liver Tumor

摘　　要：目的:探讨肝细胞癌(hepatocellular carcinoma,HCC)伴门脉癌栓放疗疗效及程氏分型对其预后判断的指导意义。方法:回顾性分析2010年1月至2016年10月解放军总医院第三医学中心收治的105例HCC伴门脉癌栓患者的资料,其中67例接受放射治疗,38例接受姑息治疗,采用Kaplan-Meier法比较放疗组和姑息组患者的总生存期及1、2、5年生存率。另外按程氏分型分组,比较门脉癌栓Ⅱ、Ⅲ、Ⅳ型放疗患者的总生存期,并采用log-rank检验及Cox回归模型分析门脉癌栓放疗的独立预后影响因素。结果:放疗组中位总生存期为9个月,1年、2年、5年生存率分别为41.8%、20.1%、4.5%,姑息组中位总生存期为3个月,1年、2年、5年生存率分别为2.6%、0、0,放疗组生存预后明显优于姑息组(P <0.001)。接受放疗的门脉癌栓Ⅱ、Ⅲ、Ⅳ型患者中位总生存期分别为13个月、8个月、5个月,Ⅱ型患者的总生存期优于Ⅲ型(P=0.011),Ⅲ型优于Ⅳ型(P=0.044)。多因素分析显示:门脉癌栓分型、肿瘤数目和照射剂量是放疗患者生存的独立预后因素(P=0.041,P=0.028,P=0.015)。结论:放疗是HCC伴门脉癌栓的有效治疗手段,程氏分型可初步为HCC伴门脉癌栓放疗提供更精细的预后判断。Objective: To evaluate the efficiency of radiotherapy(RT) for unresectable hepatocellular carcinoma(HCC) with portal vein tumor thrombosis(PVTT) and the significance of Cheng’s classification for the prognosis.Methods: A retrospective analysis was performed on 105 patients with HCC with PVTT in the Third Medical Center of PLA General Hospital from January 2010 to October 2016, among whom 67 underwent RT and 38 received palliative care.Survival analysis of the two treatment groups was performed with Kaplan-Meier and then stratified by Cheng’s classification of PVTT. And the prognostic factors were analyzed.Results: The median survival,1-year, 2-year and 5-year survival rate of RT group and palliative group was 9 vs. 3 months,41.8% vs. 2.6%, 20.1% vs. 0, 4.5% vs. 0. On subgroup analysis of PVTT, the median survival in the RT group for type Ⅱ, Ⅲ,and Ⅳ PVTT was 13, 8, and 5 months, respectively. In RT group, the survival of type Ⅲ was better than type Ⅳ(P = 0.044),but inferior to type Ⅱ(P = 0.011). PVTT type, tumor number and RT dose were independent prognostic factors for survival(P= 0.041, P = 0.028, P = 0.015).Conclusions: Radiotherapy is an effective treatment compared with palliative care for HCC and PVTT, and Cheng’s classification can initially provide a better prognosis evaluation for HCC with PVTT who underwent radiotherapy.

关 键 词：放疗 肝细胞癌 门脉癌栓 分型 

分 类 号：R735.7[医药卫生—肿瘤]