• 1. 復(fù)旦大學(xué)附屬中山醫(yī)院放療科（上海 200032）;;
  • 2.復(fù)旦大學(xué)附屬中山醫(yī)院肝癌研究所（上海 200032）;;
  • 3. 復(fù)旦大學(xué)附屬中山醫(yī)院放射科（上海 200032）;

目的 　研究原發(fā)性肝細(xì)胞肝癌伴門靜脈癌栓接受外放療患者的療效和預(yù)后因素。
方法 　回顧性分析2000年1月至2009年11月期間在復(fù)旦大學(xué)附屬中山醫(yī)院放療科進(jìn)行外放射治療的126例原發(fā)性肝細(xì)胞肝癌伴門靜脈癌栓患者的臨床資料。采用6MX或15MV光子，針對癌栓（部分包括肝內(nèi)腫瘤）外照射，劑量30～60Gy，中位劑量50Gy，常規(guī)分割。生存分析采用單因素及COX回歸多因素分析。
結(jié)果 　多因素分析顯示白蛋白水平、AFP、肝功能Child-Pugh分級、肝內(nèi)腫瘤控制情況、淋巴結(jié)轉(zhuǎn)移情況和放療方法是獨(dú)立的預(yù)后因素。放療劑量與生存無顯著性相關(guān)。
結(jié)論 　在肝細(xì)胞肝癌患者中，外放療治療門靜脈癌栓是安全而有效的。但是，姑息性放療劑量不是肝細(xì)胞肝癌合并門靜脈癌栓患者的預(yù)后因素。

引用本文： 侯佳舟,曾昭沖,張建英,樊嘉,周儉,曾蒙蘇. 姑息性放療劑量不是肝細(xì)胞癌合并門靜脈癌栓患者的預(yù)后因素. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(3): 247-251. doi: 復(fù)制

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2. Park KW， Park JW， Choi JI， et al. Survival analysis of 904 patients with hepatocellular carcinoma in a hepatitis B virus-endemic area [J]. J Gastroenterol Hepatol， 2008，23(3)：467-473.
3. Fong Y， Sun RL， Jarnagin W， et al. An analysis of 412 cases of hepatocellular carcinoma at a Western Center [J]. Ann Surg，1999， 229(6)：790-800.
4. Cheung TK， Lai CL， Wong BC， et al. Clinical features， biochemical parameters， and virological profiles of patients with hepatocellular carcinoma in Hong Kong [J]. Aliment Pharmacol Ther， 2006， 24(4)：573-583.
5. Takizawa D， Kakizaki S， Sohara N， et al. Hepatocellular carcinoma with portal vein tumor thrombosis： clinical characteristics，prognosis， and patient survival analysis [J]. Dig Dis Sci， 2007，52(11)：3290-3295.
6. Jang JW， Bae SH， Choi JY， et al. A combination therapy with transarterial chemo-lipoidolization and systemic chemo-infusion for large extensive hepatocellular carcinoma invading portal vein in comparison with conservative management [J]. Cancer Chemother Pharmacol， 2007， 59(1)：9-15.
7. Okada S. How to manage hepatic vein tumour thrombus in hepatocellular carcinoma [J]. J Gastroenterol Hepatol， 2000， 15(4)：346-348.
8. Le Treut YP， Hardwigsen J， Ananian P， et al. Resection of hepa中國普外基礎(chǔ)與臨床雜志2012 年3 月第19 卷第3 期 Chin J Bases Clin General Surg, Vol. 19, No. 3, Mar. 2012 ? 251 ?tocellular carcinoma with tumor thrombus in the major vasculature.A European case-control series [J]. J Gastrointest Surg，2006， 10(6)：855-862.
9. Lee IJ， Chung JW， Kim HC， et al. Extrahepatic collateral artery supply to the tumor thrombi of hepatocellular carcinoma invading inferior vena cava： the prevalence and determinant factors [J]. J Vasc Interv Radiol， 2009， 20(1)：22-29.
10. Ando E， Tanaka M， Yamashita F， et al. Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis： Analysis of 48 cases [J]. Cancer， 2002，95(3)：588-595.
11. Hawkins MA， Dawson LA. Radiation therapy for hepatocellular carcinoma： from palliation to cure [J]. Cancer， 2006， 106(8)：1653-1663.
12. Krishnan S， Dawson LA， Seong J， et al. Radiotherapy for hepatocellular carcinoma： an overview [J]. Ann Surg Oncol， 2008，15(4)：1015-1024.
13. Zeng ZC， Fan J， Tang ZY， et al. A comparison of treatment combinations with and without radiotherapy for hepatocellular carcinoma with portal vein and/or inferior vena cava tumor thrombus [J]. Int J Radiat Oncol Biol Phys， 2005， 61(2)：432-443.
14. Igaki H， Nakagawa K， Shiraishi K， et al. Three-dimensional conformal radiotherapy for hepatocellular carcinoma with inferior vena cava invasion [J]. Jpn J Clin Oncol， 2008， 38(6)：438-444.
15. Bruix J， Sherman M; Practice Guidelines Committee， et al. Management of hepatocellular carcinoma [J]. Hepatol， 2005， 42(5)：1208-1236.
16. Tazawa J， Maeda M， Sakai Y， et al. Radiation therapy in combination with transcatheter arterial chemoembolization for hepatocellular carcinoma with extensive portal vein involvement [J]. J Gastroenterol Hepatol， 2001， 16(6)：660-665.
17. Ishikura S， Ogino T， Furuse J， et al. Radiotherapy after transcatheter arterial chemoembolization for patients with hepatocellular carcinoma and portal vein tumor thrombus [J]. Am J Clin Oncol， 2002， 25(2)：189-193.
18. Yamada K， Izaki K， Sugimoto K， et al. Prospective trial of combined transcatheter arterial chemoembolization and three-dimensional conformal radiotherapy for portal vein tumor thrombus in patients with unresectable hepatocellular carcinoma [J]. Int J Radiat Oncol Biol Phys， 2003， 57(1)：113-119.
19. Koo JE， Kim JH， Lim YS，et al. Combination of transarterial chemoembolization and three-dimensional conformal radiotherapy for hepatocellular carcinoma with inferior vena cava tumor thrombus [J]. Int J Radiat Oncol Biol Phys， 2010， 78(1)：180-187.
20. Valla DC， Condat B. Portal vein thrombosis in adults： pathophysiology，pathogenesis and management [J]. J Hepatol，2000， 32(5)：865-871.
  1. 1. Pirisi M， Avellini C， Fabris C， et al. Portal vein thrombosis in hepatocellular carcinoma： age and sex distribution in an autopsy study [J]. J Cancer Res Clin Oncol， 1998， 124(7)：397-400.
  2. 2. Park KW， Park JW， Choi JI， et al. Survival analysis of 904 patients with hepatocellular carcinoma in a hepatitis B virus-endemic area [J]. J Gastroenterol Hepatol， 2008，23(3)：467-473.
  3. 3. Fong Y， Sun RL， Jarnagin W， et al. An analysis of 412 cases of hepatocellular carcinoma at a Western Center [J]. Ann Surg，1999， 229(6)：790-800.
  4. 4. Cheung TK， Lai CL， Wong BC， et al. Clinical features， biochemical parameters， and virological profiles of patients with hepatocellular carcinoma in Hong Kong [J]. Aliment Pharmacol Ther， 2006， 24(4)：573-583.
  5. 5. Takizawa D， Kakizaki S， Sohara N， et al. Hepatocellular carcinoma with portal vein tumor thrombosis： clinical characteristics，prognosis， and patient survival analysis [J]. Dig Dis Sci， 2007，52(11)：3290-3295.
  6. 6. Jang JW， Bae SH， Choi JY， et al. A combination therapy with transarterial chemo-lipoidolization and systemic chemo-infusion for large extensive hepatocellular carcinoma invading portal vein in comparison with conservative management [J]. Cancer Chemother Pharmacol， 2007， 59(1)：9-15.
  7. 7. Okada S. How to manage hepatic vein tumour thrombus in hepatocellular carcinoma [J]. J Gastroenterol Hepatol， 2000， 15(4)：346-348.
  8. 8. Le Treut YP， Hardwigsen J， Ananian P， et al. Resection of hepa中國普外基礎(chǔ)與臨床雜志2012 年3 月第19 卷第3 期 Chin J Bases Clin General Surg, Vol. 19, No. 3, Mar. 2012 ? 251 ?tocellular carcinoma with tumor thrombus in the major vasculature.A European case-control series [J]. J Gastrointest Surg，2006， 10(6)：855-862.
  9. 9. Lee IJ， Chung JW， Kim HC， et al. Extrahepatic collateral artery supply to the tumor thrombi of hepatocellular carcinoma invading inferior vena cava： the prevalence and determinant factors [J]. J Vasc Interv Radiol， 2009， 20(1)：22-29.
  10. 10. Ando E， Tanaka M， Yamashita F， et al. Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis： Analysis of 48 cases [J]. Cancer， 2002，95(3)：588-595.
  11. 11. Hawkins MA， Dawson LA. Radiation therapy for hepatocellular carcinoma： from palliation to cure [J]. Cancer， 2006， 106(8)：1653-1663.
  12. 12. Krishnan S， Dawson LA， Seong J， et al. Radiotherapy for hepatocellular carcinoma： an overview [J]. Ann Surg Oncol， 2008，15(4)：1015-1024.
  13. 13. Zeng ZC， Fan J， Tang ZY， et al. A comparison of treatment combinations with and without radiotherapy for hepatocellular carcinoma with portal vein and/or inferior vena cava tumor thrombus [J]. Int J Radiat Oncol Biol Phys， 2005， 61(2)：432-443.
  14. 14. Igaki H， Nakagawa K， Shiraishi K， et al. Three-dimensional conformal radiotherapy for hepatocellular carcinoma with inferior vena cava invasion [J]. Jpn J Clin Oncol， 2008， 38(6)：438-444.
  15. 15. Bruix J， Sherman M; Practice Guidelines Committee， et al. Management of hepatocellular carcinoma [J]. Hepatol， 2005， 42(5)：1208-1236.
  16. 16. Tazawa J， Maeda M， Sakai Y， et al. Radiation therapy in combination with transcatheter arterial chemoembolization for hepatocellular carcinoma with extensive portal vein involvement [J]. J Gastroenterol Hepatol， 2001， 16(6)：660-665.
  17. 17. Ishikura S， Ogino T， Furuse J， et al. Radiotherapy after transcatheter arterial chemoembolization for patients with hepatocellular carcinoma and portal vein tumor thrombus [J]. Am J Clin Oncol， 2002， 25(2)：189-193.
  18. 18. Yamada K， Izaki K， Sugimoto K， et al. Prospective trial of combined transcatheter arterial chemoembolization and three-dimensional conformal radiotherapy for portal vein tumor thrombus in patients with unresectable hepatocellular carcinoma [J]. Int J Radiat Oncol Biol Phys， 2003， 57(1)：113-119.
  19. 19. Koo JE， Kim JH， Lim YS，et al. Combination of transarterial chemoembolization and three-dimensional conformal radiotherapy for hepatocellular carcinoma with inferior vena cava tumor thrombus [J]. Int J Radiat Oncol Biol Phys， 2010， 78(1)：180-187.
  20. 20. Valla DC， Condat B. Portal vein thrombosis in adults： pathophysiology，pathogenesis and management [J]. J Hepatol，2000， 32(5)：865-871.