三维适形放疗与肝切除术治疗伴有门静脉癌栓的肝细胞癌的比较。

Comparison of three-dimensional conformal radiotherapy and hepatic resection in hepatocellular carcinoma with portal vein tumor thrombus.

机构信息

Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, China.

Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, China.

出版信息

Cancer Med. 2018 Sep;7(9):4387-4395. doi: 10.1002/cam4.1708. Epub 2018 Jul 31.

OBJECTIVE

This study aimed to evaluate the safety and efficacy of three-dimensional conformal radiotherapy (3D-CRT) and hepatic resection for patients with hepatocellular carcinoma (HCC) involving portal vein tumor thrombus (PVTT).

METHODS

We retrospectively analyzed 323 HCC patients involving PVTT. Among them, 134 patients underwent 3D-CRT, while 189 controls treated with hepatic resection (HR). Survival rate and prognostic analysis were performed using Kaplan-Meier method and Cox regression analyses.

RESULTS

The 1-, 2-, and 3-year overall survival (OS) of RT group and HR group was 54% vs 62%, 33% vs 47%, and 18% vs 43%, respectively (P = 0.003). In the subgroup of PVTT type analysis, the 1-, 2-, and 3-year OS in RT group was 65%, 39%, and 19%, respectively, while that in HR group was 83%, 53%, and 42%, respectively, in type I PVTT (P < 0.001). The 1-, 2-, and 3-year OS in RT group was 52%, 35%, and 11%, while that in HR group was 55%, 42%, and 25%, respectively, in type II PVTT (P = 0.612). In type III PVTT, the 1-, 2-, and 3-year OS in RT group was 16%, 3%, and 0%, respectively, while that in HR group was 11%, 0%, and 0%, respectively (P = 0.041). Multivariate analysis revealed that tumor size ≥10 cm, Child-Pugh class B, and type III PVTT are independent predictors of poor prognosis in HCC with PVTT.

CONCLUSION

3D-CRT appears to be an effective treatment for patients with HCC involving type II/III PVTT.

目的

本研究旨在评估三维适形放疗（3D-CRT）联合肝切除术治疗伴有门静脉癌栓（PVTT）的肝细胞癌（HCC）患者的安全性和有效性。

方法

我们回顾性分析了 323 例伴有 PVTT 的 HCC 患者。其中，134 例患者接受 3D-CRT，189 例对照患者接受肝切除术（HR）。采用 Kaplan-Meier 法和 Cox 回归分析进行生存率和预后分析。

结果

RT 组和 HR 组的 1 年、2 年和 3 年总生存率（OS）分别为 54%比 62%、33%比 47%和 18%比 43%（P=0.003）。在 PVTT 类型分析的亚组中，RT 组 1 年、2 年和 3 年 OS 分别为 65%、39%和 19%，而 HR 组分别为 83%、53%和 42%，在 I 型 PVTT 中（P<0.001）。RT 组 1 年、2 年和 3 年 OS 分别为 52%、35%和 11%，而 HR 组分别为 55%、42%和 25%，在 II 型 PVTT 中（P=0.612）。在 III 型 PVTT 中，RT 组 1 年、2 年和 3 年 OS 分别为 16%、3%和 0%，而 HR 组分别为 11%、0%和 0%（P=0.041）。多因素分析显示，肿瘤直径≥10cm、Child-Pugh 分级 B 级和 III 型 PVTT 是伴有 PVTT 的 HCC 预后不良的独立预测因素。