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减量化疗肝动脉栓塞治疗肝癌合并门脉癌栓的研究
作者:赵志英  黄佩新  杨毕伟  唐文清  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 治疗结果 存活率 回顾性研究 
DOI:R735.7;R730.53
出版年,卷(期):页码:2014,29(5):423-426
摘要:
目的 研究减量化疗肝动脉栓塞治疗伴有门脉癌栓原发性肝癌的安全性及疗效。方法 回顾性分析172例经减量化疗肝动脉栓塞治疗的伴有门脉主干和(或)一级分支癌栓的原发性肝癌。其中合并门脉一级分支癌栓者76例,合并门脉主干(包括同时合并门脉一级分支)癌栓者96例。结果 172例肝癌的中位生存期为8.0月,1、2、3年生存率分别为39.5%、22.3%、17.0%。伴有门脉一级分支癌栓与伴有门脉主干癌栓的两组患者平均生存时间差异无统计学意义(18.2月 vs 18.5月,P>0.05);两组1、2、3年生存率差异无统计学意义(39.1%、15.7%、13.7% vs 39.8%、29.3%、20.3%,P>0.05)。单因素及多因素生存分析显示,肿瘤大小及AFP水平是生存时间的影响因素。172例患者共行377次介入,无消化道大出血、肝功能衰竭、肺栓塞等严重并发症。结论 减量化疗肝动脉栓塞治疗伴有门脉癌栓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 portal vein thrombosis.Methods One-hundred-and-seventy-two patients with primary liver cancer underwent dose-reduced TACE,including 76 patients with first branch portal vein thrombosis and 96 with major portal vein thrombosis.The efficacy and safety were retrospectively evaluated.Results The overall median survival time of all patients was 8.0 months,and 1-,2-and 3-year cumulative survival rates were 39.5%,22.3% and 17.0%,respectively.There were no significant differences in average survival time(18.2 vs 18.5 months,P>0.05) and 1-,2-,3-year cumulative survival rates(39.1%,15.7%,13.7% vs 39.8%,29.3%,20.3%; P>0.05) between patients with first branch portal vein thrombosis and major portal vein thrombosis.Univariate and multivariate analysis showed that tumor size and AFP level were independent predicting factors for survival.Among 172 patients receiving 377 dose-reduced TACE treatments,no severe complications including gastrointestinal bleeding,liver failure and pulmonary embolism were found.Conclusion Dose-reduced transarterial chemoembolization for primary liver cancer patients with portal vein thrombosis is safe and effective.
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