背景:肝癌并发门静脉高压症患者在治疗方面面临着复杂的挑战。
目的:评价射频消融联合索拉非尼改善肝功能的疗效及其对预后的影响。
方法:对2014年5月至2019年3月100例肝癌合并门脉高压患者资料进行分析,根据治疗方案分为研究组(50例)和对照组(50例)。研究组接受射频消融(RFA)联合索拉非尼,对照组仅接受RFA。观察研究组和对照组的短期疗效。比较两组治疗前后肝功能及门静脉高压。甲胎蛋白(AFP),磷脂酰肌醇蛋白聚糖-3(GPC-3),比较两组治疗前后AFP-L3水平。观察两组不良反应发生情况。比较两组患者的3年生存率。比较存活组和非存活组之间的基本数据。探讨肝癌合并门脉高压患者预后不良的独立危险因素。采用多因素logistic回归分析。
结果:当比较两组时,研究组总有效率(82.00%)明显大于对照组(56.00%,P<0.05)。治疗后,丙氨酸氨基转移酶和天冬氨酸氨基转移酶水平升高,两组门静脉压力均下降。研究组各项指标改善程度明显大于对照组(P<0.05)。治疗后,法新社,两组的GPC-3和AFP-L3水平均下降,研究组水平明显低于对照组(P<0.05)。腹泻的发病率,皮疹,恶心和呕吐,研究组疲乏程度明显大于对照组(P<0.05)。1-,2-,研究组的3年生存率(94.00%,84.00%,72.00%,分别)显着大于对照组(80.00%,64.00%,和40.00%,分别;P<0.05)。在Child-Pugh等级方面,存活组和非存活组之间观察到显着差异。肝炎病史,肿瘤的数量,肿瘤大小,索拉非尼的用途,肝癌的阶段,组织学分化,脾切除术史等基本资料(P<0.05)。Logistic回归分析表明,高Child-Pugh等级,肿瘤大小(6-10厘米),肝炎病史,不用索拉非尼,肝癌IIIC期,和既往脾切除是肝癌合并门脉高压患者预后不良的独立危险因素(P<0.05)。
结论:患有肝癌并发门静脉高压症的患者受益于RFA和索拉非尼的联合治疗,因为它可以有效地恢复肝功能并提高生存率。肝癌合并门静脉高压症患者的预后与高Child-Pugh分级等因素密切相关,肿瘤大小(6-10厘米),肝炎病史,缺乏索拉非尼的使用,IIIC期肝癌,和之前的脾切除术。
BACKGROUND: Patients with liver cancer complicated by portal hypertension present complex challenges in treatment.
OBJECTIVE: To evaluate the efficacy of radiofrequency ablation in combination with sorafenib for improving liver function and its impact on the prognosis of patients with this condition.
METHODS: Data from 100 patients with liver cancer complicated with portal hypertension from May 2014 to March 2019 were analyzed and divided into a study group (n = 50) and a control group (n = 50) according to the treatment regimen. The research group received radiofrequency ablation (RFA) in combination with sorafenib, and the control group only received RFA. The short-term efficacy of both the research and control groups was observed. Liver function and portal hypertension were compared before and after treatment. Alpha-fetoprotein (AFP), glypican-3 (GPC-3), and AFP-L3 levels were compared between the two groups prior to and after treatment. The occurrence of adverse reactions in both groups was observed. The 3-year survival rate was compared between the two groups. Basic data were compared between the survival and non-surviving groups. To identify the independent risk factors for poor prognosis in patients with liver cancer complicated by portal hypertension, multivariate logistic regression analysis was employed.
RESULTS: When comparing the two groups, the research group\'s total effective rate (82.00%) was significantly greater than that of the control group (56.00%; P < 0.05). Following treatment, alanine aminotransferase and aspartate aminotransferase levels increased, and portal vein pressure decreased in both groups. The degree of improvement for every index was substantially greater in the research group than in the control group (P < 0.05). Following treatment, the AFP, GPC-3, and AFP-L3 levels in both groups decreased, with the research group having significantly lower levels than the control group (P < 0.05). The incidence of diarrhea, rash, nausea and vomiting, and fatigue in the research group was significantly greater than that in the control group (P < 0.05). The 1-, 2-, and 3-year survival rates of the research group (94.00%, 84.00%, and 72.00%, respectively) were significantly greater than those of the control group (80.00%, 64.00%, and 40.00%, respectively; P < 0.05). Significant differences were observed between the survival group and the non-surviving group in terms of Child-Pugh grade, history of hepatitis, number of tumors, tumor size, use of sorafenib, stage of liver cancer, histological differentiation, history of splenectomy and other basic data (P < 0.05). Logistic regression analysis demonstrated that high Child-Pugh grade, tumor size (6-10 cm), history of hepatitis, no use of sorafenib, liver cancer stage IIIC, and previous splenectomy were independent risk factors for poor prognosis in patients with liver cancer complicated with portal hypertension (P < 0.05).
CONCLUSIONS: Patients suffering from liver cancer complicated by portal hypertension benefit from the combination of RFA and sorafenib therapy because it effectively restores liver function and increases survival rates. The prognosis of patients suffering from liver cancer complicated by portal hypertension is strongly associated with factors such as high Child-Pugh grade, tumor size (6-10 cm), history of hepatitis, lack of sorafenib use, liver cancer at stage IIIC, and prior splenectomy.