World J Gastroenterology:化学栓塞术对肝细胞癌患者短期和长期预后的影响

2021-04-06 MedSci原创 MedSci原创

原发性肝癌是目前最常见的恶性肿瘤之一,并且是全世界恶性肿瘤死亡和发病的前五位原因之一。肝细胞癌(HCC)是最常见的病理类型,约占所有原发性肝癌的90%。

      原发性肝癌是目前最常见的恶性肿瘤之一,并且是全世界恶性肿瘤死亡和发病的前五位原因之一。肝细胞癌(HCC)是最常见的病理类型,约占所有原发性肝癌的90%。由于其生物学和解剖学特征,HCC在肝癌进展过程中容易侵入门静脉并形成门静脉肿瘤血栓形成(PVTT)。一些报告提出,PVTT引起的HCC发生率约为44%-62.2%。伴有PVTT的HCC与不良预后密切相关,并可能导致肝内转移,肝功能损害,门脉高压,上消化道出血和其他并发症。

 

      先前的研究表明,PVTT的HCC应归类为巴塞罗那临床肝癌的C期,并且不再适合手术治疗,然而另一些研究人员指出,与保守治疗相比,经肝动脉栓塞术(TACE)是一种安全有效的治疗选择。但是,有些患者在TACE术后短期内死亡,并且预期术后生存时间少于3 月的患者可能不适合TACE。为了阐明行TACE的患有PVTT的HCC患者的短期和长期生存相关性,科学家进行了本项研究。

 

 

      研究人员回顾性分析了2015年1月至2019年7月在重庆医科大学第二附属医院接受TACE治疗的181例PVTT肝癌患者的病例资料。然后通过比较TACE后3个月和12个月内死亡和存活的患者的术前指标,探讨了短期和长期预后因素。使用逻辑回归进行多变量分析。受试者工作特征曲线下的面积(曲线下的面积)用于评估与短期和长期预后相关的因素的预测能力。

 

      本项研究发现接受TACE治疗的PVTT肝癌患者中位生存时间为4.8 个月。3个月,6个月和12 个月的生存率分别为68.5%,38.7%和15.5%。在多变量分析中,总胆红素,性别和天冬氨酸转氨酶(AST)与短期存活率密切相关。当AST≥87 U/L和总胆红素≥16.15 µmol/L时,TACE后3个月生存率显着降低(P <0.05)。AST具有最佳的预测能力,其次是总胆红素,而性别对曲线下的短期生存区的预测能力最差:0.763(AST)vs. 0.707(总胆红素)vs 0.554(性别)。单病灶患者的长期生存结果明显好于≥三个病灶的患者(P=0.009)。与结节性和弥漫性HCC患者相比,单发性HCC患者的长期生存期较差(P=0.001)。

图:化学栓塞术对肝细胞癌患者的生存影响

      研究人员通过本项研究证实天冬氨酸转氨酶(AST),总胆红素和性别是与接受TACE治疗的PVTT肝癌患者短期生存相关的独立因素。肿瘤的数量和肿瘤病理类型与长期预后相关。

 

 

原始出处:

Chen KL, Gao J. Factors influencing the short-term and long-term survival of hepatocellular carcinoma patients with portal vein tumor thrombosis who underwent chemoembolization. World J Gastroenterol 2021; 27(13): 1330-1340

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    2021-07-14 许安
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    2021-09-06 xjy02
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    2021-04-08 JZ Yang

    TACE combo吧

    0

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