TACE联合直线加速器三维适形放疗治疗中晚期原发性肝癌患者近期临床疗效研究

doi:10.3969/j.issn.1672-5069.2023.03.029

摘要/Abstract

摘要： 目的探讨采用经导管动脉栓塞化疗(TACE)联合直线加速器三维适形放疗(3D-CRT)治疗中晚期原发性肝癌(PLC)患者的近期临床疗效及其影响因素。方法 2015年1月～2020年9月收治的中晚期PLC患者89例,给予所有患者TACE联合3D-CRT治疗。在治疗后3月,行影像学检查考核疗效。应用单因素和多因素Logistic回归分析影响TACE联合3D-CRT治疗中晚期PLC患者近期临床疗效的因素。结果在治疗结束后3个月,获得完全缓解(CR)17例,部分缓解(PR)43例,疾病稳定(SD)21例和疾病进展(PD)8例,有效率为71.9%;单因素分析结果显示,有效组患者BCLC分期B期占比为71.7%,显著高于无效组的34.5%(P＜0.05),Child-Pugh A级占比为76.7%,显著高于无效组的48.3%(P＜0.05),肿瘤直径＜5.0 cm占比为46.7%,显著高于无效组患者的20.7%(P＜0.05),血清甲胎蛋白(AFP)＜400.0 μg/L占比为81.7%,显著高于无效组的34.5%(P＜0.05),中性粒细胞与淋巴细胞比值(NLR)＜3占比为53.3%,显著高于无效组的31.0%(P＜0.05),预后营养指数(PNI)≥45占比为75.0%,显著高于无效组的31.0%(P＜0.05);多因素分析显示Child-Pugh B级(OR=1.749)、AFP＞400.0 μg/L(OR=1.988)和PNI＜45(OR=1.627)是影响TACE联合3D-CRT治疗中晚期PLC患者近期临床疗效的独立危险因素(P＜0.05)。结论采用TACE联合3D-CRT治疗中晚期PLC患者近期临床疗效较好,临床医生可根据患者临床资料选择最适合的患者给予治疗。

关键词: 原发性肝癌, 经导管动脉栓塞化疗, 直线加速器三维适形放疗, 治疗

Abstract: Objective The purpose of this study was to investigate the short-term clinical efficacy of transcatheter arterial chemoembolization (TACE) and three-dimensional conformal radiotherapy(3D-CRT) in the treatment of patients with advanced primary liver cancer (PLC). Methods 89 patients with advanced PLC were admitted to our hospital between January 2015 and September 2020, and all the patients were treated with TACE and 3D-CRT combination therapy. The short-term clinical efficacy were evaluated, and the multivariate Logistic regression analysis was conducted to explore the influencing factors on the short-term clinical efficacy. Results At the end of three-month treatment, the effective rate was 71.9% in our series, including complete remission (CR) 17 cases, partial remission (PR) in 43 cases, stable disease (SD) in 21 cases and progression of disease (PD) in 8 cases; the univariate Logistic regression analysis showed that the percentage of BCLC stage B, Child-Pugh class A, tumor diameter less than 5 cm, serum AFP less than 400.0 μg/L, the neutrophils to lymphocytes ratio (NLR) and the prognostic nutritional index (PNI) in patients with CR/PR were 71.7%, 76.7%,46.7%,81.7%,53.3% and 75.0%, all significantly different compared to 34.5%, 48.3%, 20.7%, 34.5%, 31.0% and 31.0%(P＜0.05); the multivariate Logistic regression analysis showed that the Child-Pugh class B (OR=1.749), serum AFP level >400.0 μg/L(OR=1.988), and PNI<45(OR=1.627) were the independent risk factors affecting the short-term clinical efficacy (P＜0.05). Conclusion The short-term clinical efficacy of TACE and 3D-CRT combination in dealing with patients with advanced PLC is good, and the clinicians should choose the appropriate and eligible patients to receive the protocol for improved efficacy.

Key words: Hepatoma, Transcatheter arterial chemoembolization, Linear accelerator three-dimensional conformal radiotherapy, Therapy

唐亮, 陈曦, 王文高, 董超. TACE联合直线加速器三维适形放疗治疗中晚期原发性肝癌患者近期临床疗效研究[J]. 实用肝脏病杂志, 2023, 26(3): 416-419.

Tang Liang, Chen Xi, Wang Wengao. Short-term clinical efficacy of TACE and 3D-CRT in the treatment of patients with advanced primary liver cancer[J]. Journal of Practical Hepatology, 2023, 26(3): 416-419.

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