| 叶婷,曾昭冲,杜世锁,孙菁,吴志峰,陈一兴,杨平,胡永,赵倩倩,张建英.肝细胞肝癌心膈角或膈上淋巴结转移放疗疗效及预后因素分析[J].中华放射医学与防护杂志,2021,41(6):431-435 |
| 肝细胞肝癌心膈角或膈上淋巴结转移放疗疗效及预后因素分析 |
| Effect of radiation therapy and prognostic factors in hepatocellular cancer patients with cardiophrenic angle or superior diaphragmatic lymph nodes metastasis |
| 投稿时间：2020-09-23 |
| DOI：10.3760/cma.j.issn.0254-5098.2021.06.006 |
| 中文关键词: 心膈角 膈上 淋巴结 肝细胞肝癌 放射治疗 |
| 英文关键词:Cardiophrenic angle Superior diaphragmatic Lymph node Hepatocellular cancer Radiation therapy |
| 基金项目: |
| 作者 | 单位 | E-mail | | 叶婷 | 复旦大学附属中山医院厦门医院放疗科, 厦门 361015 | | | 曾昭冲 | 复旦大学附属中山医院放疗科 复旦大学附属中山医院肿瘤防治中心, 上海 200032 | zeng.zhaochong@zs-hospital.sh.cn | | 杜世锁 | 复旦大学附属中山医院放疗科 复旦大学附属中山医院肿瘤防治中心, 上海 200032 | | | 孙菁 | 复旦大学附属中山医院放疗科 复旦大学附属中山医院肿瘤防治中心, 上海 200032 | | | 吴志峰 | 复旦大学附属中山医院放疗科 复旦大学附属中山医院肿瘤防治中心, 上海 200032 | | | 陈一兴 | 复旦大学附属中山医院放疗科 复旦大学附属中山医院肿瘤防治中心, 上海 200032 | | | 杨平 | 复旦大学附属中山医院放疗科 复旦大学附属中山医院肿瘤防治中心, 上海 200032 | | | 胡永 | 复旦大学附属中山医院放疗科 复旦大学附属中山医院肿瘤防治中心, 上海 200032 | | | 赵倩倩 | 复旦大学附属中山医院放疗科 复旦大学附属中山医院肿瘤防治中心, 上海 200032 | | | 张建英 | 复旦大学附属中山医院放疗科 复旦大学附属中山医院肿瘤防治中心, 上海 200032 | |
|
| 摘要点击次数: 3185 |
| 全文下载次数: 966 |
| 中文摘要: |
| 目的 研究肝细胞肝癌（HCC）患者心膈角或膈上淋巴结转移（LNM）放疗的疗效和预后因素。方法 回顾性分析复旦大学附属中山医院2010年1月至2020年8月56例心膈角或膈上LNM的HCC患者病例资料。按1月是否接受外照射分为外照射组和非外照射组，每组28例。外照射组放射野包括或不包括原发灶，非外照射组未给予任何针对心膈角或膈上LNM的局部治疗。比较两组的缓解率、生存率、局部控制率、预后因素。结果 外照射后部分缓解和完全缓解的患者分别为9例（32.1%）和9例（32.1%）。中位生存外照射组为16.1个月（95%CI 9.00~23.21，RR=3.63），非外照射组为6.9个月（95%CI 4.63~8.77，RR=1.06），两组比较差异有统计学意义（χ2=15.53，P<0.05）。心膈角或膈上LNM 1年局部控制率，外照射组为37.0%，非外照射组为10.7%，差异有统计学意义（χ2=5.28，P<0.05）。确诊心膈角或膈上LNM后，3个月内甲胎蛋白（AFP）较外照射前升高，外照射组4例（14.3%），非外照射组13例（46.4%），两组比较差异有统计学意义（χ2=6.84，P<0.05）。多变量分析结果显示，同时伴有肝内肿瘤多发、肝内肿瘤>5 cm、AFP≥400 μg/L、未行外照射者预后差。结论 心膈角或膈上LNM的HCC患者行外照射能延长总生存、提高LNM局部控制率。伴有肝内肿瘤多发、肝内肿瘤>5 cm、AFP≥400 μg/L、未行外照射者预后差。 |
| 英文摘要: |
| Objective To study the effects of radiotherapy and the prognostic factors in hepatocellular cancer (HCC) patients with cardiophrenic angle or superior diaphragmatic lymph nodes metastasis (LNM). Methods We retrospectively analyzed 56 HCC patients with cardiophrenic angle or superior diaphragmatic LNM who were treated with or without external beam radiation therapy (EBRT) in Zhongshan Hospital of Fudan University from Jan 2010 to Aug 2020. Patients were divided into two groups according to whether they received radiotherapy, EBRT group and non-EBRT group, and each group had 28 patients. Radiation fields included or excluded primary tumor in EBRT group, and the cardiophrenic angle or superior diaphragmatic LNM did not receive any local treatment in non-EBRT group. The response rate, survival rate, local control rate, prognostic risk factors of the two groups were studied. Results After EBRT, the partial response rate and complete response rate were 32.1%(9/28) and 32.1%(9/28). The median survival rate of EBRT group was 16.1 months (95%CI 9.00-23.21,RR=3.63) vs. 6.9 months (95%CI4.63-8.77,RR=1.06) for the non-EBRT group, with statistically significant difference (χ2=15.53, P<0.05). Cardiophrenic angle or superior diaphragmatic lymph nodes 1-year local control rate for EBRT group and non-EBRT group were 37.0% vs. 10.7%, with statistically significant difference (χ2=5.28, P<0.05). Since diagnosis of cardiophrenic angle or superior diaphragmatic LNM, 4 patients (14.3%) in the EBRT group vs. 13 patients (46.4%) in the non-EBRT group had higher alpha-fetoprotein (AFP) level after 3 months compared with the AFP before EBRT (χ2=6.84, P<0.05). Multivariate analysis showed that multiple intrahepatic tumors, maximal diameter of intrahepatic tumors>5 cm, AFP≥400 μg/L, no EBRT were poor prognostic factors. Conclusions EBRT can prolong overall survival and improve the control rate of lymph node of HCC patients with cardiophrenic angle or superior diaphragmatic LNM. Patients with multiple intrahepatic tumors, maximal diameter of intrahepatic tumors>5 cm, AFP≥400 μg/L and no EBRT have poor prognosis. |
| HTML 查看全文 查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|