三维适形放疗治疗原发性肝癌患者疗效及发生放射性肝损伤影响因素分析*

doi:10.3969/j.issn.1672-5069.2024.01.027

摘要/Abstract

摘要： 目的分析采用三维适形放疗(3DCRT)治疗原发性肝癌(PLC)患者的疗效和放射性肝损伤(RILI)发生的影响因素。方法 2019年4月～2022年4月我院诊治的PLC患者85例,均接受3DCRT治疗。按照实体瘤疗效评价标准考核疗效,根据报道的标准诊断RILI。应用Logistic回归模型分析影响PLC患者接受3D-CRT治疗疗效和RILI发生的因素。结果经3D-CRT治疗,本组获得客观缓解50例(58.8%);客观缓解组TNM Ⅳ期和Child-Pugh B级占比分别为36.0%和14.0%,均显著低于非客观缓解组的60.0%和48.6%(P<0.05),而单次剂量为3～4 Gy和总剂量为50～60 Gy占比分别为52.0%和68.0%,均显著高于非客观缓解组的28.6%和45.7%(P<0.05);本组发生RILI者15例(17.7%);RILI组TNM Ⅳ期和Child-Pugh B级、单次剂量为3～4 Gy和总剂量50～60 Gy占比分别为80.0%、93.0%、73.3%和86.7%,均显著高于无RILI组(分别为38.6%、14.3%、35.7%和52.9%,P<0.05);多因素Logistic回归分析发现,TNM分期、Child-Pugh分级、单次剂量和总剂量均为影响3DCRT治疗的疗效和发生RILI的因素(OR=5.078、4.988、4.600、4.850、4.963、5.043、5.150、4.740,P<0.05)。结论 PLC患者接受3DCRT治疗的疗效和RILI的发生受TNM分期、Child-Pugh分级、单次剂量和总剂量的影响,临床在制定放疗计划时,要充分考虑以上敏感因素,以保证提高疗效并显著降低RILI的发生。

关键词: 原发性肝癌, 三维适形放疗, 放射性肝损伤, 治疗, 影响因素

Abstract: Objective The aim of this study was to investigate the short-term efficacy of three-dimensional conformal radiotherapy (3DCRT) in patients with primary liver cancer (PLC) and to analyze the influencing factors for radiation-induced liver injury (RILI) occurrence. Methods 85 patients with PLC were encountered in our hospital between April 2019 and April 2022, and all received 3DCRT therapy. The short-term efficacy was evaluated by RECIST, and the RILI was diagnosed based on liver function tests. The multivariate Logistic regression analysis was applied to reveal the factors impacting the efficacy and the occurrence of RILI. Results After the 3D-CRT treatment, the objective remission rate (ORR) was 58.8% in our series; the percentages of TNM stage Ⅳ and Child-Pugh class B in 50 patients with objective remission were 36.0% and 14.0%, both significantly lower than 60.0% and 48.6%(P<0.05), while the percentages of single dose of 3-4 Gy and total dose of 50-60 Gy were 52.0% and 68.0%, both significantly higher than 28.6% and 45.7%(P<0.05) in those without objective remission; the prevalence of RILI was 17.7% during the 3D-CRT therapy; the percentages of TNM stage Ⅳ, Child-Pugh class B, single dose of 3-4 Gy and total dose of 50-60 Gy in 15 patients with RILI were 80.0%, 93.0%, 73.3% and 86.7%, all significantly higher than 38.6%, 14.3%, 35.7% and 52.9% (P<0.05) in 70 patients without RILI; the multivariate Logistic regression analysis showed that the TNM stage, Child-Pugh classification, single dose and total dose were all the independent risk factors impacting the efficacy and the occurrence of RILI(OR=5.078, 4.988, 4.600, 4.850, 4.963, 5.043, 5.150, 4.740, respectively, P<0.05). Conclusion The efficacy of 3DCRT treatment in patients with PLC and the occurrence of RILI are influenced by TNM staging, Child-Pugh class, single dose and total dose, so the clinicians should fully consider the above sensitive factors when making the radiotherapy plans to ensure the improved efficacy and less incidence of RILI.

Key words: Hepatoma, Three-dimensional conformal radiotherapy, Radiation- induced liver injury, Therapy, Impacting factors

包天舒, 杜野牧, 姚善文, 冯鹤云. 三维适形放疗治疗原发性肝癌患者疗效及发生放射性肝损伤影响因素分析^*[J]. 实用肝脏病杂志, 2024, 27(1): 105-108.

Bao Tianshu, Du Yemu, Yao Shanwen, et al. Short-term efficacy of three-dimensional conformal radiotherapy in patients with primary liver cancer[J]. Journal of Practical Hepatology, 2024, 27(1): 105-108.

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三维适形放疗治疗原发性肝癌患者疗效及发生放射性肝损伤影响因素分析^*

Short-term efficacy of three-dimensional conformal radiotherapy in patients with primary liver cancer

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