【摘要】 目的评价索拉非尼联合PVA化疗栓塞(PVA-TACE)治疗肝癌合并肝动-静脉分流(HAVS)的疗效及预后因素。方法 110例肝癌合并HAVS患者,采用索拉非尼+PVA-TACE治疗(治疗组)17例,PVA-TACE治疗(对照组)93例。依据HAVS的分流速度,采用不同大小的PVA化疗栓塞分流道。随访并分析生存期、并发症等。采用Kaplan-Meier法计算累计生存率,预后因素采用Cox模型分析。结果治疗组与对照组中位生存期(overall survival,OS)分别为12.8个月和7.7个月,两组有统计学意义(χ~2=3.907,P=0.048)。两组6、12个月生存率分别为78.8%、45.5%,66.7%、23.6%。多因素分析结果显示:联合索拉非尼(HR=0.351,P=0.007)及多次栓塞(HR=0.498,P=0.018)为独立保护因素,术前AFP≥400 ng/ml(HR=1.984,P=0.018)为独立危险因素。结论索拉非尼联合PVA-TACE治疗中晚期肝癌并HAVS安全、有效,疗效优于单纯PVA-TACE;术前AFP低表达及多次栓塞治疗患者的预后较好。更多还原

【Abstract】 Objective To evaluate the curative effect of sorafenib plus percutaneous transcatheter arterial chemoembolization(TACE) with polyvinyl alcohol(PVA) in treating hepatocellular carcinoma(HCC)associated with hepatic arteriovenous shunts(HAVS), and to discuss the factors which might influence the prognosis. Methods A total of 110 patients with HCC complicated by HAVS were enrolled in this study.Sorafenib plus PVA-TACE was employed in 17 patients(study group), and only PVA-TACE was adopted in 93patients(control group). According to the velocity of HAVS, different sized PVA particles were separately used to obstruct the shunts. All the patients were followed up, and the overall survival(OS), postoperative complications, etc. were analyzed. By using Kaplan-Meier method, the cumulative survival rates were calculated, and multivariate Cox proportional hazard model was used to analyze the survival prognostic factors. Results The median overall survivals of the study group and the control group were 12.8 months and7.7 months, respectively. The difference between the two groups was statistically significant(χ2=3.907, P=0.048). The 6-month and 12-month survival rates of the study group were 78.8% and 45.5% respectively,and those for the control group were 66.7% and 23.6% respectively. Cox multivariate survival analysis revealed that combination use of sorafenib(HR=0.351, P=0.007) and multiple embolization procedures(HR=0.498,P=0.018) were independent protection factors, while preoperative AFP value ≥400 ng/ml(HR=1.984,P =0.018) was an independent risk factor. Conclusion For the treatment of HCC complicated by HAVS,sorafenib plus PVA-TACE is safe and effective, its therapeutic effect is superior to simple PVA-TACE.Usually, satisfactory survival prognosis can be expected in patients who have lower preoperative AFP level and who have received multiple embolization procedures.更多还原