摘要
目的观察肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)结合外放射治疗大肝癌的远期效果并分析预后因素.方法以TACE结合外放射治疗107例大肝癌患者(肝肿瘤最大径5～18 cm).观察近期效果与生存率,并用Cox比例风险模型分析预后因素.结果48.6%的病例获得肿瘤缓解,1、3、5年累积生存率分别为59.4%、28.4%、15.8%.肿瘤数目、放疗剂量为独立的预后因素.单发肿瘤者的累积生存率(1、3、5年分别为75.8%、43.9%、26.8%)明显高于肝内肿瘤多发者(1、3年分别为313%、5.0%,P=0.000 5).放疗剂量40Gy以上者的生存率(1、3、5年分别为95.8%、74.7%、37.4%)明显高于剂量20～40Gy者(分别为60.9%、20.7%、10.3%)与剂量低于20Gy者(分别为26.7%、7 1%、7.1%=0.000 1).结论TACE结合外放射为治疗不能切除大肝癌的有效方法.肿瘤数目为影响预后的最重要的临床因素.在肝脏可耐受的范围内给予最高剂量的放疗是提高疗效的关键.
ve To observe the long-term effects of combined transcatheter arterial chemoembolization(TACE) and radiotherapy for patients with large hepatocellular carcinoma (HCC) and to analyze the prognostic factors.Methods A total of l07 patients with large unresectable HCC (the largest diameter of tumor ranged from 5 to l8 cm ) weretreated with TACE followed by external-beam irradiation. Acute effects and survival rates were observed. The Cox propor-tional hazards model was used to analyze the prognostic factors. Results An objective response was achieved in 48.6% ofthe cases. The cumulative survival rates at l, 3, and 5 years were 59.4%, 28.4%, and l5.8%, respectively. The tumor numberand irradiation dose were the independent prognostic factors. The cumulative survival rates of the patients with a solitarylesion (75.8%, 43.9%, and 26.8% at l, 3, and 5 years, respectively) were significantly higher than those with multiple lesions(3l.3%, and 5.0% at l and 3 years, respectively, P=0.0005). The survival rates of the patients received irradiation above 40Gy (95.8%, 74.7%, and 37.4% at l, 3, and 5 years, respectively) were significantly higher than those received 20~40Gy (60.9%. 20.7%, and l0.3%, respectively) and those received radiation lower than 20 Gy (26.7%, 7.l%, and 7.l%,respectively, P=0.000l). Conclusions Combined TACE with radiotherapy is a promising treatment for largeunresectable HCC. The number of tumor is the most important clinical prognostic factor. De1ivering the highest irradiationdose within the tolerance of the liver is the key to improve the long-term effect.
出处
《中华肝脏病杂志》
CAS
CSCD
2002年第3期167-169,共3页
Chinese Journal of Hepatology
