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中华介入放射学电子杂志 ›› 2016, Vol. 04 ›› Issue (03) : 136 -141. doi: 10.3877/cma.j.issn.2095-5782.2016.03.003

所属专题： 文献；

肿瘤介入

PVA-TACE治疗肝癌并肝动-静脉分流的疗效及生存预后
刘秋松1, 梅雀林2,†()   
  1. 1. 361004　福建厦门，厦门大学附属中山医院肿瘤与血管介入科
    2. 510515　广东广州，南方医科大学南方医院介入科
  • 收稿日期:2016-04-20 出版日期:2016-08-01
  • 通信作者: 梅雀林

Evaluation of polyvinyl alcohol transcatheter arterial chemoembolization in treating hepatocellular carcinoma with hepatic arteriovenous shunts and its prognosis

Qiusong Liu1, Quelin Mei2,†()   

  1. 1. Department of Interventional Radiology, Affiliated Zhongshan Hospital, Xiamen University, Xiamen 361004, China
    2. Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
  • Received:2016-04-20 Published:2016-08-01
  • Corresponding author: Quelin Mei
  • About author:
    Corresponding author: Mei Quelin, Email:
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刘秋松, 梅雀林. PVA-TACE治疗肝癌并肝动-静脉分流的疗效及生存预后[J]. 中华介入放射学电子杂志, 2016, 04(03): 136-141.

Qiusong Liu, Quelin Mei. Evaluation of polyvinyl alcohol transcatheter arterial chemoembolization in treating hepatocellular carcinoma with hepatic arteriovenous shunts and its prognosis[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2016, 04(03): 136-141.

目的：

探讨聚乙烯醇微粒肝动脉化疗栓塞（PVA-TACE）治疗肝细胞癌（HCC）并肝动-静脉分流（HAVS）的疗效预测及生存预后影响因素分析。

方法：

回顾性分析113例HCC并HAVS，依据分流速度不同采用不同规格PVA化疗栓塞。依据疗效分为肿瘤控制组（A组，63例）与肿瘤进展组（B组，50例），随访并分析生存期，采用Kaplan-Meier法计算累积生存率，疗效预测因素采用多因素logistic回归分析，生存预后因素采用Cox模型分析。

结果：

113例患者的中位生存期（OS）为11.0个月。A、B组中位OS分别为14.5个月、9.2个月，两组患者的生存期差异有统计学意义（χ2=15.215，P<0.001）。多因素logistic回归分析显示：肿瘤分布于单叶（OR=0.222，P=0.003）及无癌栓形成（OR=0.126，P=0.024）患者的疗效较好。多因素Cox回归分析显示：年龄≤50岁（HR=0.616，P=0.049）、多次栓塞治疗（HR=0.550，P=0.039）及肿瘤控制（HR=0.443，P=0.002）为预后的独立保护因素，而肿瘤负荷>50%（HR=3.156，P<0.001）及分流栓塞程度较低（HR=2.011，P=0.002）为预后的独立危险因素。

结论：

PVA-TACE治疗HCC并HAVS是安全、有效的。肿瘤单叶分布及无血管癌栓侵犯肿瘤控制较好。肿瘤负荷较大及分流栓塞程度较低患者预后较差，年轻、多次栓塞治疗及肿瘤控制的患者预后较好。

关键词: 癌，肝细胞, 动-静脉分流, 生存预后, 聚乙烯醇, 肝动脉化疗栓塞术
Objective:

To evaluate the efficacy of polyvinyl alcohol transcatheter arterial chemoembolization (PVA-TACE) in the treatment of hepatocellular carcinoma (HCC) with hepatic arteriovenous shunts (HAVS) and its prognosis among these patients.

Methods:

113 patients with HCC and HAVS were collected who were divided into two groups according to their responding to the therapeutics-group A (tumor control, n=63) and group B (tumor progress, n=50). Based on HAVS types, different sizes of PVA were used to embolize the shunts accordingly. The overall survival (OS) was analyzed in the follow-up study. Factors associated with efficacy were evaluated using multivariate logistic regression analysis. The survival prognostic factors were assessed by multivariate Cox analysis.

Results:

The median OS of 113 patients was 11.0 months. The median OS of the group A and group B patients were 14.5 months and 9.2 months, respectively. The survival curves of the two groups were estimated by the Kaplan–Meier method and compared by a Log-rank test, which revealed a significant difference between two groups (χ2=15.215, P<0.001). On multivariate logistic analysis, tumor location (OR=0.222, P=0.003) and tumor thrombosis (OR=0.126, P=0.024) were significant factors for efficacy. Independent prognostic factors for a longer survival included: patient age ≤50 years (HR=0.616, P=0.049), multiple embolization (HR=0.550, P=0.039) and tumor control (HR=0.443, P=0.002). While tumor burden >50% (HR=3.156, P<0.001) and lower level of shunts occlusion were considered independent risk factors.

Conclusions:

PVA-TACE is a safe and effective strategy for HCC with HAVS , especially for single-lobe tumor and without tumor thrombosis. Younger age, multiple embolization and tumor control show a better survival prognosis. Patients with tumor burden>50% and lower level of shunts occlusion show a poor survival prognosis.

Key words: carcinoma, hepatocellular, arteriovenous shunts, prognosis, polyvinyl alcohol
表1 肿瘤控制组和肿瘤进展组患者的基线情况
参数 A组（63例） B组（50例） χ2值 P值
中位年龄 ≤50岁 28 30 2.676 0.102
? >50岁 35 20 ? ?
肿瘤分布 单叶 55 32 8.469 0.004
? 双叶 8 18 ? ?
肿瘤边界 局限型 53 35 3.203 0.074
? 浸润型 10 15 1.109 0.292
肿瘤负荷 ≤50% 39 26
? >50% 24 24
BCLC分期a A 4 0 0.796 0.372
? B 8 14 ? ?
? C 51 36 ? ?
血管癌栓形成 无 14 17 1.741 0.187
? 有 49 33 ? ?
AFP水平（μg/L） <400 29 17 1.657 0.198
? ≥400 34 33 ? ?
图1 肿瘤控制组和肿瘤进展组的累积生存曲线图
图2 患者男，52岁，原发性肝癌（块状型），中速型肝动脉-门静脉分流及肝动脉-肝静脉分流
图3 患者男，69岁，原发性肝癌（巨块型）合并门静脉右支、肝右静脉癌栓形成，中速型肝动脉-肝静脉分流
表2 PVA-TACE治疗HCC合并HAVS的疗效的影响因素分析
因素 B SE Waldχ2 P值 OR（95%CI）
术前BCLC分期a -1.432 0.835 2.944 0.086 0.239（0.046～1.226）
AFP -0.733 0.445 2.707 0.100 0.481（0.201～1.150）
肿瘤边界 -0.928 0.518 3.210 0.073 0.395（0.143～1.091）
肿瘤分布 -1.506 0.510 8.719 0.003 0.222（0.082～0.603）
癌栓形成 -2.071 0.920 5.073 0.024 0.126（0.021～0.764）
表3 影响HCC合并HAVS患者生存期的单、多因素分析
因素 单因素分析 多因素分析
χ2 P值 HR 95%CI P值
年龄 3.522 0.061 0.616 0.380～0.998 0.049
肿瘤负荷 18.016 <0.001 3.156 1.930～5.162 <0.001
栓塞次数 11.929 0.001 0.550 0.311～0.971 0.039
分流栓塞程度 7.678 0.053 2.011 1.279～3.161 0.002
奥沙利铂总量 5.858 0.016 ? ? ?
肿瘤控制情况 15.215 <0.001 0.443 0.262～0.748 0.002
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