Effect of radiation therapy and prognostic factors in hepatocellular cancer patients with cardiophrenic angle or superior diaphragmatic lymph nodes metastasis
10.3760/cma.j.issn.0254-5098.2021.06.006
- VernacularTitle:肝细胞肝癌心膈角或膈上淋巴结转移放疗疗效及预后因素分析
- Author:
Ting YE
1
;
Zhaochong ZENG
;
Shisuo DU
;
Jing SUN
;
Zhifeng WU
;
Yixing CHEN
;
Ping YANG
;
Yong HU
;
Qianqian ZHAO
;
Jianying ZHANG
Author Information
1. 复旦大学附属中山医院厦门医院放疗科，厦门 361015
- Keywords:
Cardiophrenic angle;
Superior diaphragmatic;
Lymph node;
Hepatocellular cancer;
Radiation therapy
- From:
Chinese Journal of Radiological Medicine and Protection
2021;41(6):431-435
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To study the effects of radiotherapy and the prognostic factors in hepatocellular cancer (HCC) patients with cardiophrenic angle or superior diaphragmatic lymph nodes metastasis (LNM).Methods:We retrospectively analyzed 56 HCC patients with cardiophrenic angle or superior diaphragmatic LNM who were treated with or without external beam radiation therapy (EBRT) in Zhongshan Hospital of Fudan University from Jan 2010 to Aug 2020. Patients were divided into two groups according to whether they received radiotherapy, EBRT group and non-EBRT group, and each group had 28 patients. Radiation fields included or excluded primary tumor in EBRT group, and the cardiophrenic angle or superior diaphragmatic LNM did not receive any local treatment in non-EBRT group. The response rate, survival rate, local control rate, prognostic risk factors of the two groups were studied.Results:After EBRT, the partial response rate and complete response rate were 32.1%(9/28) and 32.1%(9/28). The median survival rate of EBRT group was 16.1 months (95% CI 9.00-23.21, RR=3.63) vs. 6.9 months (95% CI 4.63-8.77, RR=1.06) for the non-EBRT group, with statistically significant difference ( χ2=15.53, P<0.05). Cardiophrenic angle or superior diaphragmatic lymph nodes 1-year local control rate for EBRT group and non-EBRT group were 37.0% vs. 10.7%, with statistically significant difference ( χ2=5.28, P<0.05). Since diagnosis of cardiophrenic angle or superior diaphragmatic LNM, 4 patients (14.3%) in the EBRT group vs. 13 patients (46.4%) in the non-EBRT group had higher alpha-fetoprotein (AFP) level after 3 months compared with the AFP before EBRT ( χ2=6.84, P<0.05). Multivariate analysis showed that multiple intrahepatic tumors, maximal diameter of intrahepatic tumors >5 cm, AFP≥400 μg/L, no EBRT were poor prognostic factors. Conclusions:EBRT can prolong overall survival and improve the control rate of lymph node of HCC patients with cardiophrenic angle or superior diaphragmatic LNM. Patients with multiple intrahepatic tumors, maximal diameter of intrahepatic tumors >5 cm, AFP≥400 μg/L and no EBRT have poor prognosis.
