未手术肝癌患者放化疗的选择策略

Selection Strategy of Chemoradiotherapy in Patients with Unoperated Hepatocellular Carcinoma

摘要: 目的：为不同分期分型的未手术肝癌患者选择具体放化疗方式提供临床策略。方法：基于SEER数据库，回顾性分析了2017年至2020年符合入排标准的3286例患者的临床数据资料，组间比较采用X2检验，Kaplan-Meier法绘制生存曲线，单因素分析采用Log-rank检验，多因素分析采用COX回归模型。结果：未手术肝癌患者的预后与肿瘤分化程度、临床分期、M分期、肿瘤大小、放疗、化疗及放疗 + 化疗有关(P < 0.05)。肿瘤分化程度、临床分期、M分期、肿瘤大小是影响未手术肝癌患者的独立危险因素，放疗、化疗及放疗 + 化疗是未手术肝癌患者的独立保护因素。选择放化疗的未手术肝癌患者比未选择放化疗的患者中位生存期(MST)长(P < 0.05)；选择放疗 + 化疗的高分化 + 中分化、III + IV、M1及肿瘤直径 ≥ 5 cm的患者MST长(P < 0.05)；选择放疗的M0及肿瘤直径 ≤ 2 cm的患者MST较长(P < 0.05)。结论：相对于未选择放化疗的未手术肝癌患者，选择不同放化疗方式的患者均能显著提高生存率及MST。处于高分化 + 中分化组、III + IV组、M1组及肿瘤直径 ≥ 5 cm组的未手术肝癌患者选择放疗 + 化疗的预后更好。M0及肿瘤直径 ≤ 2 cm的未手术肝癌患者选择放疗的预后更好。

Abstract: Objective: To provide clinical strategies for the selection of specific radiotherapy and chemotherapy in patients with inoperative liver cancer at different stages and types. Methods: Based on SEER da-tabase, the clinical data of 3286 patients who met the inclusion criteria from 2017 to 2020 were retrospectively analyzed. X2 test was used for inter group comparison, Kaplan Meier method was used to draw the survival curve, log rank test was used for univariate analysis, and Cox regression model was used for multivariate analysis. Results: The prognosis of patients with unresected liver cancer was related to tumor differentiation, clinical stage, M stage, tumor size, radiotherapy, chem-otherapy and radiotherapy + chemotherapy (P < 0.05). The degrees of tumor differentiation, clinical stage, M stage and tumor size are independent risk factors for patients with unresected liver cancer. Radiotherapy, chemotherapy and radiotherapy + chemotherapy are independent protective factors for patients with unresected liver cancer. The median survival time (MST) of patients with liver cancer who chose radiotherapy and chemotherapy was longer than that of patients who did not choose radiotherapy and chemotherapy (P < 0.05); The MST length of patients with radiotherapy + chemotherapy, high differentiation + medium differentiation, iii + iv, M1 and tumor diameter ≥ 5 cm was selected (P < 0.05); MST was longer in patients with M0 and tumor diameter ≤ 2 cm after radiotherapy (P < 0.05). Conclusion: Compared with the patients who did not choose radiotherapy and chemotherapy, the patients who chose different radiotherapy and chemotherapy can signifi-cantly improve the survival rate and MST. Patients with unresected liver cancer who are in the high differentiation + medium differentiation group, iii + iv group, M1 group and tumor diameter ≥ 5 cm group choose radiotherapy + chemotherapy for better prognosis. Patients with M0 and tumor di-ameter ≤ 2 cm who have not been operated on have better prognosis if they choose radiotherapy.