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减量化疗肝动脉栓塞治疗肝癌合并白细胞和(或)血小板减少的研究
作者:杨毕伟  唐文清  赵志英  陈荣新  葛宁灵  陈漪  邹静怀  夏景林 
单位:1. 复旦大学附属中山医院肝肿瘤内科  肝癌研究所  上海 200032 
2.
 复旦大学附属闵行医院 上海市闵行区中心医院  上海 201100 
关键词:肝肿瘤/药物疗法 肝动脉 抗肿瘤药/投药和剂量 化学栓塞 治疗性 白细胞减少 血小板减少 存活率 回顾性研究 
DOI:R735.7;R730.53
出版年,卷(期):页码:2014,29(5):417-422
摘要:
目的 研究减量化疗肝动脉栓塞对伴有白细胞和(或)血小板减少的原发性肝癌治疗的安全性及有效性。方法 回顾性分析292例行减量化疗肝动脉栓塞治疗的原发性肝癌病例。所有病例伴有白细胞≤3.0×109/L和(或)血小板≤50×109/L。全组292例分成3组,A组伴有白细胞减少85例;B组伴有血小板减少41例;C组同时伴有白细胞和血小板减少166例。结果 全组中位生存期23.0月,1年生存率72.2%;A、B和C组中位生存期分别为26.0月、36.0月和20.0月,1年生存率分别为73.6%、87.5%和69.5%。对292例患者作单因素及多因素生存分析显示,白细胞≤2.0×109/L(r=0.657,P=0.016)、肿瘤> 5 cm(r=3.175,P=0.000)和白蛋白≤35 g/L(r=0.452,P=0.000)是生存时间的独立影响因素,血小板计数不是生存的影响因素。60例(20.5%)患者在介入治疗术前和(或)术后使用重组人粒细胞集落刺激因子(granulocyte colony stimulating factor,G-CSF),用药与否对生存没有影响。介入术后1月内随访白细胞与血小板均无明显下降,所有患者无严重骨髓抑制发生。结论 减量化疗肝动脉栓塞治疗伴有白细胞和(或)血小板减少的原发性肝癌是安全有效的。
Objective To evaluate the safety and efficacy of dose-reduced transarterial chemoembolization(TACE)for primary liver cancer patients with leukocytopenia and/or thrombocytopenia.Methods The clinical data of 292 primary liver cancer patients with white blood cell count(WBC)≤3.0×109/L and/or blood platelet count(BPC)≤50×109/L undergoing dose-reduced TACE were retrospectively analyzed.The patients were divided into 3 groups:group A with WBC≤3.0×109/L(n=85),group B with BPC≤50×109/L(n=41) and group C with WBC≤3.0×109/L and BPC≤50×109/L(n=166).Results The median overall survival time and 1-year cumulative survival rate were 23.0 months and 72.2%.The median overall survival time and 1-year survival rates for groups A,B and C were 26.0 months and 73.6%,36.0 months and 87.5%,20.0 months and 69.5%,respectively.Univariate and multivariate analysis showed that WBC≤2.0×109/L(r=0.657,P=0.016),tumor size 5 cm(r=3.175,P=0.000) and albumen(ALB)≤35 g/L(r=0.452,P=0.000) were independent predicting factors for overall survival,but BPC was not(P>0.05).Sixty(20.5%) patients received recombinant human granulocyte colony stimulating factor(G-CSF) pre- and/or post-intervention,but the application of G-CSF had no significant impact on survival.There was no severe myelosuppression observed and no decreased WBC and BPC one month after TACE.Conclusion Dose-reduced TACE for primary liver cancer patients with leukocytopenia and/or thrombocytopenia is safe and effective.
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