Retrospective Analysis Of The Treatment Of Primary Liver Cancer With Cyberknife

Objectives:Collect the clinical data of patients with primary liver cancer treated by cyberknife stereotactic radiotherapy,describe and analyze the treatment effect,tumor markers and blood biochemical index changes and prognosis,and provide the clinical decision and prognosis for the cyberknife treatment of primary liver cancer.Efficacy evaluation provides a reference basis.Methods:The clinical data of 309 patients with primary liver cancer who were treated with cyberknife for the first time and without previous treatment were collected from July2012 to December 2018.Perform statistical analysis on the basic condition,curative effect and prognosis of the patient,and evaluate the curative effect,prognosis,tumor markers and blood biochemical index changes.Epidata 3.1 and SPSS 24.0 software are used to enter,sort and analyze clinical data.χ~2 test,Fisher exact probability method and Logistic regression were used to analyze the local control rate of patients with primary liver cancer and its influencing factors;the rank sum test was used to analyze the changes of tumor markers,blood routine,liver function and coagulation function indicators before and after treatment;Kaplan-Meier method,Log-rank test and Cox regression model were used to analyze the prognosis of patients with primary liver cancer.Results:1.The general condition of patients with primary liver cancer:264 of the 309patients were males,accounting for 85.4%;45 were females,accounting for 14.6%.The youngest age is 16 years old,the oldest age is 88 years old,and the median age is56(47,65)years old.There were 244 patients with a history of hepatitis,accounting for 79.0%.There were 192 cases of small liver cancer,accounting for 62.1%.There were 43 patients with a cumulative dose of<40Gy,accounting for 13.9%;147 patients with a cumulative dose of 40-44Gy,accounting for 47.6%;119 patients with a cumulative dose of≥45Gy,accounting for 38.5%.Twenty-nine patients with biologically effective dose(BED)<70Gy,accounting for 9.4%;109 patients with 70-79Gy,accounting for 35.5%;97 patients with 80-89Gy,accounting for 31.4%;74patients with≥90Gy,accounting for 23.9%.2.The short-term curative effect of patients with primary liver cancer:Among 201patients with curative effect for 3 months,3 patients were in complete remission(CR),accounting for 1.5%;66 patients were in partial remission(PR),accounting for 32.9%;stable(SD)71 patients,accounting for 35.3%;61 patients with progressive(PD),accounting for 30.3%;3-month local control rate was 69.7%.Among 125 patients with6-month curative effect,2 were CR patients,accounting for 1.6%;24 were PR patients,accounting for 19.2%;49 were SD patients,accounting for 39.2%;50 were PD patients,accounting for 40.0%;6 months The local control rate is 60.0%.The results of univariate analysis showed that the presence or absence of ascites,liver cancer diameter,single dose,number of divisions,and BED had statistical significance for the 6-month local control rate of patients with primary liver cancer(P<0.05).The results of multivariate logistic regression analysis showed that The presence or absence of ascites and the number of divisions were statistically significant for the 6-month curative effect of patients with primary liver cancer(OR=4.647,0.210,P<0.05).The risk of progression in patients with ascites was 4.647 times that of patients without ascites,and the risk of progression in patients with≥4 times of segmentation was 0.210 times that of patients with less than 4 times.3.Tumor markers in patients with primary liver cancer:The difference in alpha-fetoprotein(AFP)changes before and after cyberknife treatment was statistically significant(P<0.001).After Bonferroni correction,AFP decreased 6 months after treatment compared to before treatment(P<0.001).4.Blood biochemistry in patients with primary liver cancer:After cyberknife treatment,the patients’red blood cells(RBC),platelets(PLT),alanine aminotransferase(ALT),aspartate aminotransferase(AST)and albumin(ALB)are all treated better Before treatment(Z=-3.437,-3.148,-2.197,-6.260,-6.449,P<0.05),prothrombin time(PT)was higher than before treatment(Z=-3.696,P<0.05).5.The prognosis of patients with primary liver cancer:The median survival time of 263 patients was 29.0(16.3,41.7)months,the 1-year survival rate was 65.8%,the2-year survival rate was 43.6%,and the 3-year survival rate was 35.0%.The results of univariate analysis showed that the presence or absence of hepatitis,the number of lesions,the diameter of liver cancer,clinical stage,portal vein tumor thrombus,ascites,single dose,number of divisions,and BED were statistically significant for the prognosis of patients with primary liver cancer(P<0.05)Incorporating it into the multivariate Cox regression analysis showed that the portal vein tumor thrombus was statistically significant(HR=3.472,P=0.003),and the death risk of patients with portal vein tumor thrombus was 3.404 times that of patients without portal vein tumor thrombus.Conclusion:1.The number of divisions and ascites may be independent factors that affect the local control rate of patients with primary liver cancer.2.Cyberknife treatment will have an impact on tumor markers and reduce AFP 6months after treatment.3.Cyberknife treatment will have an impact on blood routine,liver function and coagulation function,reducing the ratio of red blood cells,platelets,alanine aminotransferase,aspartate aminotransferase and albumin,and increasing prothrombin time.4.Portal vein tumor thrombus is an independent factor that may affect the prognosis of patients with primary liver cancer.