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目的探讨肝细胞肝癌患者伴门静脉和或下腔静脉癌栓接受外放射治疗的疗效。方法回顾总结近8年180例原发性肝细胞肝癌伴门静脉和或下腔静脉癌栓患者,其中66例接受直线加速器外放疗作为放疗组,114例未接受外放疗作为对照组,放疗组与对照组间影响患者的主要预后因素除肿瘤标志物有差别外,其他因素无明显差别。放疗组放疗方法为常规分割,局部放疗癌栓,放射治疗剂量介于36～60Gy(中位50Gy)。放射治疗中及治疗后随访肝功能、影像学检查和生存情况。应用Cox回归模型,多因素分析比较两组的生存期。结果66例癌栓患者接受外放射治疗,22例(33.3%)患者癌栓完全缓解,16例(24.2%)部分缓解,26例(39.4%)稳定,2例(3.1%)进展;1年生存率27.9%,中位生存期7.3个月。对照组1年生存率为12.3%,中位生存期为4个月。多因素回归分析显示,外放射治疗显示出很强的保护因素(RR=0.408,P<0.001)。放疗组病人生存情况与甲胎蛋白水平无关;但与γ-GT水平、肝内病灶单多发、癌栓存在的部位有关。死亡原因多为肝内肿瘤未控制导致肝衰。对照组下腔静脉系统癌栓患者生存情况比门静脉癌栓患者差,相反,放疗组下腔静脉癌栓患者的生存情况好于门静脉癌栓患者。结论结合外放射治疗可明显延长肝细胞肝癌伴有门静脉和或下腔静脉癌栓患者的生存期,肝内原发肿瘤灶为单发的癌栓患者,放射治疗更能延长其生存期。
Objective To investigate the curative effect of external radiotherapy in patients with hepatocellular carcinoma with portal vein and or inferior vena cava tumor thrombus. Methods A retrospective review of 180 patients with primary hepatocellular carcinoma with portal vein and or vena cava tumor thrombus in the past eight years was reviewed. Among them, 66 received external beam radiotherapy as a radiotherapy group and 114 received external radiotherapy as a control group. Radiotherapy group and The main prognostic factors affecting patients in the control group in addition to differences in tumor markers, other factors no significant difference. Radiotherapy radiotherapy method for the conventional segmentation, local radiotherapy thrombus, radiation dose between 36 ~ 60Gy (median 50Gy). Radiotherapy and follow-up after treatment of liver function, imaging examination and survival. Cox regression model was used to compare the survival of the two groups by multivariate analysis. Results Thrombus embolization was performed in 66 patients with thrombus embolism. Thrombolysis was completely relieved in 22 patients (33.3%), partial response was relieved in 16 patients (24.2%), stable in 26 patients (39.4%) and progression in 2 patients (3.1% Survival rate of 27.9%, the median survival of 7.3 months. The 1-year survival rate was 12.3% in the control group and the median survival time was 4 months. Multivariate regression analysis showed that external radiotherapy showed a strong protective factor (RR = 0.408, P <0.001). Survival of radiotherapy group patients with alpha-fetoprotein level has nothing to do; but with γ-GT levels, single intrahepatic lesions, the presence of tumor thrombus site. Most of the causes of death for liver cancer uncontrolled lead to liver failure. In the control group, the survival of IVC thrombus patients was worse than that of portal vein thrombosis. On the contrary, the survival of patients with IVC thrombectomy was better than that of patients with portal vein thrombosis. Conclusion Combined with external radiotherapy can significantly prolong the survival of patients with hepatocellular carcinoma accompanied by portal vein and or vena cava tumor thrombus, and the primary intrahepatic tumor is a single tumor thrombus. Radiotherapy can prolong the survival of patients with hepatocellular carcinoma.