进展期肝癌患者接受肝动脉化疗栓塞术后生存获益的影响因素分析  

Analysis of factors affecting survival benefits in patients with advanced hepatocellular carcinoma after receiving transcatheter arterial chemoembolization

作　　者：徐家晨 张申 黄鹏 倪才方[1] XU Jiachen;ZHANG Shen;HUANG Peng;NI Caifang(Department of Interventional Radiology、First AffUiated Hospital of Soochow University,Suzhouy Jiangsu Province 215006,China)

机构地区：[1]苏州大学附属第一医院介入科,江苏215006

出　　处：《介入放射学杂志》2021年第4期398-402,共5页Journal of Interventional Radiology

摘　　要：目的探究进展期肝癌患者接受TACE治疗后生存获益的影响因素,进而对筛选合适治疗人群提供参考。方法回顾性分析2016年3月至2019年3月在本中心行TACE治疗的进展期肝癌患者。患者病程中只接受过TACE治疗。统计每例患者基线特征、病灶特征以及首次TACE术前相关实验室检查指标。评估首次TACE术后反应。研究终点为患者总体生存期。采用Cox风险回归模型多因素分析得出影响患者累积生存率的独立影响因素。结果本研究共纳入87例患者,72例(82.8%)既往乙型肝炎病史,中位生存期为7.4个月。多因素分析得出5个独立影响因素:最大病灶直径(风险比HR=5.689,95%CI:2.366,13.681)、门静脉癌栓分级(HR=1.937,95%CI:1.129,3.324)、血清白蛋白(HR=2.367,95%CI:1.161,4.827)、凝血酶原时间(HR=2.177,95%CI:1.119,4.238)、mRECIST分级(HR=5.076,95%CI:2.391,10.776)。5个因素对生存期的影响差异均有统计学意义。结论最大病灶直径≥7 cm,门静脉癌栓累积一级分支或主干,血清白蛋白、凝血酶原时间指标异常的进展期肝癌患者在TACE治疗中很大可能无法生存获益。首次TACE术后病灶反应情况对于生存期有一定的预测作用。Objective To discuss the factors affecting survival benefits in patients with advanced hepatocellular carcinoma(HCC)after receiving transcatheter arterial chemoembolization(TACE),so as to provide reference for selection of patients who are suitable for TACE treatment.Methods The clinical data of 87 patients with advanced HCC,who received TACE at the First Affiliated Hospital of Soochow University of China during the period from March 2016 to March 2019,were retrospectively analyzed.During the course of disease,the patients only received TACE therapy.The baseline characteristics,lesion features and relevant laboratory tests before initial TACE procedure of each patient were collected.The clinical response after initial TACE was evaluated.The endpoint of study was overall survival(OS).Cox proportional hazards model was used to analyze the independent impact factors affecting the cumulative survival rate.Results Of the 87 patients enrolled in this study,72(83%)had a history of hepatitis B.The median OS was 7.4 months.Multivariate analysis showed that there were five independent impact factors:maximal diameter of lesion(HR=5.689,95%CI:2.366-13.681),portal vein tumor thrombus(PVTT)grade(HR=1.937,95%CI:1.129-3.324),serum level of albumin(HR=2.367,95%CI:1.161-4.827),prothrombin time(PT)(HR=2.177.95%CI:1.119-4.238),and m RECIST grade(HR=5.076,95%CI:2.391-10.776).The above five independent impact factors had statistically significant effect on the survival time.Conclusion Advanced HCC patients,who have maximal lesion diameter≥7 cm,PVTT involving first branch or trunk of portal vein,abnormal serum albumin level and abnormal PT,are most probably not able to get survival benefit from TACE treatment.Tumor response to the initial TACE treatment has certain predictive value for survival time.

关 键 词：进展期肝癌 肝动脉化疗栓塞术 总体生存期 预后分析 

分 类 号：R735.7[医药卫生—肿瘤]