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小肝癌立体定向放射治疗的效果及预后分析
Clinical effect of stereotactic body radiotherapy in treatment of patients with small hepatocellular carcinoma and related prognostic factors
文章发布日期:2018年08月07日  来源:  作者:李甜甜, 孙静, 王权,等  点击次数:579次  下载次数:99次

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【摘要】: 摘要:目的探讨小肝癌患者接受立体定向放射治疗的疗效、安全性以及影响预后的因素。方法回顾性分析2011年3月-2014年10月于解放军三〇二医院行立体定向放射治疗的64例小肝癌患者的临床资料。随访患者的肿瘤控制情况和治疗后不良反应。Kaplan-Meier法分析生存情况;log-rank检验和Cox比例风险模型分析影响生存的相关因素。结果共纳入64例患者72个病灶。随访4~60个月,中位随访时间44个月。44个病灶(61.1%)完全缓解,20个病灶(27.8%)部分缓解,5个病灶(6.9%)稳定,3个病灶(4.2%)进展。客观有效率88.9%,1、3、5年局部控制率分别为94.4%、88.1%、78.7%。1、3、5年累积生存率分别为95.3%、71.6%、55.9%;无进展生存率分别为62.3%、33.5%、10.8%。不良反应多为1~2级。1例患者出现了胆红素升高4级反应。另外,约1/4患者出现了3级白细胞和(或)血小板的降低,治疗后1年左右均恢复至基线水平。多因素分析显示,白蛋白-胆红素分级和肿瘤数目为影响立体定向放射治疗后小肝癌患者累积生存率的独立危险因素。结论立体定向放射治疗小肝癌安全有效,白蛋白-胆红素分级和肿瘤数目与治疗后患者的生存率有关。
【Abstract】:ObjectiveTo investigate the clinical effect and safety of stereotactic body radiotherapy (SBRT) in patients with small hepatocellular carcinoma and related prognostic factors. MethodsA retrospective analysis was performed for the clinical data of 64 patients with small hepatocellular carcinoma who underwent SBRT in 302 Hospital of PLA from March 2011 to October 2014. The patients were followed up for tumor control and adverse events after treatment. The Kaplan-Meier method was used to calculate survival rates, log-rank test and the Cox proportional hazards model was used to analyze the influencing factors for survival. ResultsA total of 64 patients with 72 lesions were enrolled in this study. The patients were followed up for 4-60 months, with a median follow-up time of 44 months. Of all lesions, 44 (61.1%) achieved complete response, 20 (27.8%) achieved partial response, 5 (6.9%) achieved a stable state, and 3 (4.2%) had progression. The objective response rate was 88.9%. The 1-, 3-, and 5-year local control rates were 94.4%, 88.1%, and 78.7%, respectively, the 1-, 3-, and 5-year cumulative survival rates were 95.3%, 71.6% and 55.9%, respectively, and the 1-, 3-, and 5-year progression-free survival rates were 62.3%, 33.5%, and 10.8%, respectively. Most of the adverse events were grade 1-2 events. One patient experienced a grade 4 elevated bilirubin. In addition, about one fourth of the patients experienced grade 3 leukopenia and/or thrombocytopenia, which increased to the baseline level at 1 year after treatment. The multivariate analysis showed that albumin-bilirubin (ALBI) grade and number of tumors were independent risk factors for the cumulative survival rate of patients with small hepatocellular carcinoma after SBRT. ConclusionSBRT is safe and effective in the treatment of small hepatocellular carcinoma, and ALBI grade and number of tumors are associated with the survival rate of patients after treatment.
【关键字】:肝肿瘤; 放射疗法; 预后
【Key words】:
【引证本文】:LI TT, SUN J, WANG Q, et al. Clinical effect of stereotactic body radiotherapy in treatment of patients with small hepatocellular carcinoma and related prognostic factors[J]. J Clin Hepatol, 2018, 34(8): 1702-1706. (in Chinese)
李甜甜, 孙静, 王权, 等. 小肝癌立体定向放射治疗的效果及预后分析[J]. 临床肝胆病杂志, 2018, 34(8): 1702-1706.

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