Potential prognostic benefits of radiotherapy as an initial treatment for patients with unresectable advanced hepatocellular carcinoma with invasion to intrahepatic large vessels
Potential prognostic benefits of radiotherapy as an initial treatment for patients with unresectable advanced hepatocellular carcinoma with invasion to intrahepatic large vessels
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DOI：
10.1159/000120996
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发表时间：
2007-01-01
期刊：
影响因子：
3.5
通讯作者：
Saigenji, Katsunori
中科院分区：
文献类型：
--
作者：
Nakazawa, Takahide;Adachi, Shigeru;Saigenji, Katsunori
目的：研究放射治疗（RT）对不能切除的晚期肝细胞癌（HCC）伴肝内大血管（IHLV）浸润患者的疗效和预后益处。方法：68例晚期肝癌伴IHLV浸润患者进行了研究。32名连续患者最初接受了HCC侵袭IHLV的三维适形RT。在接受RT的患者中研究肿瘤反应、预后因素和生存率。在研究组中对预后因素和生存率进行整体评估。采用Kaplan-Meier法、单变量分析和考克斯模型分析数据。结果：RT客观有效率为48%。接受RT的患者的生存预测因素是肝功能Child-Pugh A级（p = 0.0263）和RT反应（p = 0.0121）。在整个研究组中，考克斯模型中生存的独立预测因子是多结节HCC（p = 0.007）、下腔静脉侵犯（p = 0.001）、血清甲胎蛋白水平为11，000 ng/ml（p = 0.032）和RT的表现（p < 0.001）。值得注意的是，RT无应答者（n = 15）的中位生存期明显长于未接受HCC治疗的患者（n = 21; 7.0 vs. 3.4个月，p = 0.0014）。结论：RT被认为是HCC侵袭IHLV的有效初始治疗，并且由于诱导稳定的疾病，即使在无应答者中也可能提供生存益处。版权所有（C）2008 S. Karger AG，巴塞尔。
Objectives: To examine the efficacy and prognostic benefits of radiotherapy (RT) in patients who have unresectable advanced hepatocellular carcinoma (HCC) with invasion to intrahepatic large vessels (IHLVs). Methods: Sixty-eight patients who had advanced HCC with invasion to IHLVs were studied. Thirty-two consecutive patients initially received 3-dimensional conformal RT for HCC invasion to IHLVs. Tumor response, prognostic factors, and survival were studied in the patients given RT. Prognostic factors and survival were assessed in the study group as a whole. Data were analyzed using the Kaplan-Meier method, univariate analysis, and a Cox model. Results: The rate of objective response to RT was 48%. Predictors of survival in the patients who received RT were a hepatic function of Child-Pugh class A (p = 0.0263) and a response to RT (p = 0.0121). In the study group as a whole, independent predictors of survival in a Cox model were multinodular HCC (p = 0.007), inferior vena caval invasion (p = 0.001), a serum alpha-fetoprotein level of 1 1,000 ng/ml (p = 0.032), and the performance of RT (p < 0.001). Notably, the median survival of the nonresponders to RT (n = 15) was significantly longer than that of the patients who received no treatment for HCC (n = 21; 7.0 vs. 3.4 months, p = 0.0014). Conclusion: RT is considered an effective initial treatment for HCC invasion to IHLVs, and may offer survival benefits, even in nonresponders, because of the induction of stable disease. Copyright (C) 2008 S. Karger AG, Basel.