TACE联合125I放射性粒子植入或三维适形放疗对肝细胞癌伴门静脉癌栓的疗效比较

摘要

目的 比较经皮肝动脉化疗栓塞(TACE)联合125I放射性粒子植入与三维适形放疗(3DCRT)治疗肝细胞癌(HCC)伴门静脉癌栓(PVTT)的临床疗效.方法 选取HCC合并PVTT患者65例,其中32例(观察组)采用TACE联合125I放射性粒子植入治疗,33例(对照组)采用TACE联合3DCRT治疗.比较两组患者近期(治疗后3个月)疗效、生存率、住院时间与治疗费用.结果 观察组患者PVTT治疗有效率明显高于对照组(75.00％ vs 9.09％,P＜0.05).观察组患者1、2、3年生存率分别为53.1％、28.1％、12.5％,对照组患者1、2、3年生存率分别为30.3％、6.0％、0.0％.两组患者1年生存率比较差异无统计学意义(P＞0.05),观察组患者2、3年生存率均高于对照组(均P＜0.05).观察组患者住院时间明显短于对照组(P＜0.05),治疗费用明显少于对照组(P＜0.05).结论 与3DCRT相比,TACE联合125I放射性粒子植入治疗HCC伴PVTT在短期内更能有效控制癌栓进展,相对延长PVTT进展时间,提高患者的长期生存率,且可缩短住院时间、减少治疗费用.%Objective To compare the efficacy of transcather arterial chemoembolization (TACE) combined with CT-guided percutaneous 125 iodine (125I) seeds implantation or three-dimensional conformal radiotherapy (3DCRT) in treatment of advanced hepatocellular carcinoma (HCC) patients with portal vein tumor thrombi (PVTT).Methods Sixty-five HCC patients with PVTT were enrolled in this study,of whom 32 patients were received CT-guided implantation of 125I seeds (study group) and 33 patients were received 3DCRT (control group) after TACE procedure.The short-term efficacy (3 months after treatment),survival rate,length of hospitalization and overall costs were compared between two groups.Results The short-term efficacy rate in study group was significantly higher than that in control group (75.00％ vs 9.09％,P＜0.05).The 1-,2-and 3-year survival rates of study group were 53.1％,28.1％ and 12.5％ respectively,and those of control group were 30.3％,6.0％,0％ respectively.There was no significant difference in 1-year survival rate between the two groups (P ＞0.05);while the 2-year and 3-year survival rates of study group were higher than those in the control group(both P＜0.05).In addition,the length of hospital stay was shorter and the overall cost was lower in study group than those in control group (both P＜0.05).Conclusion The short-term efficacy and long-term survival of TACE combined implantation of 125I seeds are better and the length of hospital stay and overall cost are less than those of TACE combined with 3DCRT in treatment of advanced HCC patients with PVTT.