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目的评价经肝动脉介入治疗(TAIT)消化道肿瘤肝转移的疗效,并探讨影响患者预后的因素。方法266例消化道肿瘤肝转移患者,原发肿瘤为结直肠癌161例,胃癌67例,食管癌22例,胃肠间质瘤16例。共行TAIT 754例次,观察其近期疗效、远期疗效和毒副反应,对可能影响患者预后的因素进行单因素分析和多因素Cox回归分析。结果总有效率为45.4%。中位生存期为14.3个月,0.5、1、2、3和5年生存率分别为83.1%、56.8%、17.7%、9.3%和1.5%。132例患者于TAIT后1～5 d内出现轻-中度肝区不适、疼痛、恶心呕吐、低热等,无严重毒副反应发生。原发肿瘤来源、肝转移瘤数目、肝转移瘤分布、是否伴有门静脉栓子、肿瘤血供情况、原发肿瘤是否切除是消化道肿瘤肝转移TAIT治疗后患者预后的独立影响因素。结论TAIT是治疗不能根治性切除肝转移瘤的有效姑息治疗方法。食管癌来源、多发肝转移、转移瘤累及多叶、伴有门静脉栓子的患者预后较差,而富血供肿瘤、原发肿瘤已切除的患者预后较好。
Objective To evaluate the efficacy of transcatheter arterial chemoembolization (TAIT) in the treatment of hepatic metastases and to explore the factors affecting the prognosis of the patients. Methods A total of 266 patients with hepatic metastases from gastrointestinal tumors were selected. The primary tumors were 161 cases of colorectal cancer, 67 cases of gastric cancer, 22 cases of esophageal cancer and 16 cases of gastrointestinal stromal tumors. A total of 754 TAITs were performed concurrently to observe their short-term curative effect, long-term curative effect and toxic and side effects. Univariate and multivariate Cox regression analyzes were performed on the factors that may influence the prognosis of patients. The total effective rate was 45.4%. The median survival was 14.3 months, and the 0.5, 1, 2, 3, and 5-year survival rates were 83.1%, 56.8%, 17.7%, 9.3%, and 1.5%, respectively. 132 cases of patients with mild to moderate liver discomfort, pain, nausea and vomiting, fever, etc. within 1 ~ 5 days after TAIT, no serious side effects. The origin of primary tumor, the number of metastatic liver tumor, the distribution of metastatic liver tumor, the presence or absence of portal vein embolus, the blood supply of tumor and the excision of primary tumor are the independent prognostic factors of TAIT after liver metastasis of gastrointestinal tumor. Conclusion TAIT is an effective palliative treatment for patients who can not radical resect liver metastases. Esophageal cancer sources, multiple liver metastases, metastases involving multiple leaves, accompanied by portal vein emboli in patients with poor prognosis, and rich blood for the tumor, the primary tumor has been removed in patients with a better prognosis.