HBV相关肝细胞癌患者放射性肝损伤的影响因素

摘要/Abstract

摘要： 目的分析HBV相关肝细胞癌患者放射性肝损伤的影响因素。方法回顾性分析2020年9月至2022年9月常州市武进中医医院收治的200例接受SBRT的HBV相关肝细胞癌患者的临床资料,其中36例发生放射性肝损伤(发生组),164例患者为未发生组。比较两组临床资料,并作多因素分析。观察发生组患者放疗前、放疗2周、放疗4周达峰时间、曲线上升斜率、曲线下面积。结果发生组年龄>50岁、肿瘤直径>5 cm、Child-Pugh分级为C级的分别为86.1%(31/36)、47.2%(17/36)、63.9%(23/36),大于未发生组的68.3%(112/164)、25.0%(41/164)、35.4%(58/164)。白细胞计数为(3.5±1.5)×10⁹/L,低于未发生组的(5.4±1.7)×10⁹/L,(P<0.05)。多因素Logistic回归分析结果显示,年龄>50岁、肿瘤直径>5 cm、Child-Pugh分级为C级、白细胞计数减少均为影响HBV相关肝细胞癌患者接受SBRT后放射性肝损伤的独立危险因素(OR=4.614、4.968、5.233、5.496,P<0.05)。与放疗前相比,放疗2周、4周发生组患者达峰时间明显延长,曲线上升斜率、曲线下面积明显缩小(P<0.05)。结论 HBV相关肝细胞癌患者接受SBRT后可能出现放射性肝损伤,与高龄、肿瘤直径过大、肝脏储备功能差、白细胞计数减少有关。

关键词: HBV相关肝细胞癌, SBRT, 放射性肝损伤, 影响因素

Abstract: Objective To investigate the occurrence and influencing factors of radiation-induced liver injury in patients with hepatitis B hepatocellular carcinoma following stereotactic radiotherapy. Methods A retrospective analysis was conducted on the clinical data of 200 patients with hepatitis B hepatocellular carcinoma who underwent stereotactic radiotherapy at our hospital between September 2020 and September 2022. Among them, 36 patients experienced radiation-induced liver injury after treatment and were designated as the occurrence group, while the remaining 164 patients were classified as the non-occurrence group. Clinical data of the two groups were compared, and the multivariate logistic regression analysis was conducted. The study also observed the peak time, curve rising slope, and area under the curve of patients in the occurrence group before radiotherapy, 2 weeks after radiotherapy, and 4 weeks after radiotherapy. Results The proportion of patients with age >50 years old, tumor diameter >5 cm, and Child-Pugh grade C in the occurrence group (86.1%, 47.2%, 63.9%) was higher than that in the non-occurrence group (68.3%, 25.0%, 35.4%), and the white blood cell count level was [(3.5 ± 1.5) × 10⁹/L], lower than that in the non occurrence group [(5.4 ± 1.7) × 10⁹/L] (P<0.05). Multivariate logistic regression analysis revealed that age>50 years, tumor diameter>5 cm, Child Pugh grade C, and decreased white blood cell count were independent risk factors for radiation-induced liver injury in patients with hepatitis B hepatocellular carcinoma after stereotactic radiotherapy (OR=4.614, 4.968, 5.233, 5.496, P<0.05). Compared with before radiotherapy groups, the peak time of patients in the 2 week and 4 week radiotherapy groups was significantly prolonged, and the slope of curve rise and area under curve were significantly reduced (P<0.05). Conclusion Following stereotactic radiotherapy, patients with hepatitis B hepatocellular carcinoma may be at risk for radiation-induced liver injury, which is associated with older age, large tumor diameter, poor liver reserve function, and decreased white blood cell count. This warrants increased vigilance in clinical practice.

Key words: Hepatitis B hepatocellular carcinoma, Stereotactic radiotherapy, Radiation induced liver injury, influence factor

周金锋, 陈俊杰, 詹宝滨. HBV相关肝细胞癌患者放射性肝损伤的影响因素[J]. 肝脏, 2024, 29(2): 193-196.

ZHOU Jin-feng, CHEN Jun-jie, ZHAN Bao-bin. Analysis of the incidence and influencing factors of radiation induced liver injury in patients with hepatitis B hepatocellular carcinoma after stereotactic radiotherapy[J]. Chinese Hepatolgy, 2024, 29(2): 193-196.

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