高强度聚焦超声联合经动脉化疗栓塞治疗不可切除的肝细胞癌：长期随访和临床分析。

High-intensity focused ultrasound combined with transarterial chemoembolization for unresectable hepatocellular carcinoma: long-term follow-up and clinical analysis.

机构信息

Clinical Center for Tumor Therapy, 2nd Affiliated Hospital of Chongqing Medical University, and Department of Bioengineering, Chongqing Medical University, Chongqing 40010, China.

出版信息

Eur J Radiol. 2011 Dec;80(3):662-9. doi: 10.1016/j.ejrad.2010.08.042. Epub 2010 Sep 22.

DOI:10.1016/j.ejrad.2010.08.042

PMID:20864286

Abstract

OBJECTIVE

High-intensity focused ultrasound (HIFU) combined with transarterial chemoembolization (TACE) has been used to treat unresectable HCC, but its long-term effects and major prognostic factors remain to be determined. The purpose of this study was to assess its long-term effects and find major prognostic factors to help us select eligible patients in the future.

METHODS

73 patients with unresectable HCC received follow-up after HIFU+TACE. The variables of sex, age, AFP level, liver function, tumor location, tumor number, tumor size, TNM staging (5th edition), TNM staging (6th edition), portal vein invasion, ultrasonic pathway of HIFU, TACE session and ablation response were evaluated by univariate analysis. Those variables with significant difference were assessed by multivariate analysis.

RESULTS

The mean follow-up time was 11.7±11.1 months (range, 1-60 months). The median survival time and overall survival rates of 1, 2, 3-year were 12 months, 49.1%, 18.8%, 8.4%, respectively. 45.2% patients achieved complete ablation. At the end of follow-up, 51 patients (69.9%) died from tumor progression (27 patients), liver function failure (18 patients), hemorrhage of upper digestive tract (3 patients) and infection (3 patients). 1 with liver abscess, 2 with serious skin burns and 2 with rib fracture were observed after HIFU. On univariate analysis, age (P=0.017), tumor size (P=0.000), tumor number (P=0.039), the 5th edition of TNM staging (P=0.023), portal vein invasion (P=0.02) and ablation response (P=0.000) had significant difference. On multivariate analysis, ablation response (P=0.001) and tumor size (P=0.013) were major prognostic factors.

CONCLUSION

HIFU combined with TACE is a safe method with a low rate of severe complications. As major prognostic factors, ablation response and tumor size may help us predict the survival and select eligible patients clinically.

摘要

目的

高强度聚焦超声（HIFU）联合经动脉化疗栓塞（TACE）已被用于治疗不可切除的 HCC，但长期疗效和主要预后因素仍有待确定。本研究旨在评估其长期疗效，并寻找主要的预后因素，以帮助我们在未来选择合适的患者。

方法

73 例不可切除 HCC 患者接受 HIFU+TACE 治疗后随访。采用单因素分析评估性别、年龄、AFP 水平、肝功能、肿瘤部位、肿瘤数量、肿瘤大小、TNM 分期（第 5 版）、TNM 分期（第 6 版）、门静脉侵犯、HIFU 超声通路、TACE 疗程和消融反应等变量。对有显著差异的变量进行多因素分析。

结果

平均随访时间为 11.7±11.1 个月（范围，1-60 个月）。中位生存时间和 1、2、3 年的总生存率分别为 12 个月、49.1%、18.8%、8.4%。45.2%的患者达到完全消融。随访结束时，51 例（69.9%）患者因肿瘤进展（27 例）、肝功能衰竭（18 例）、上消化道出血（3 例）和感染（3 例）死亡。HIFU 后观察到 1 例肝脓肿、2 例严重皮肤烧伤和 2 例肋骨骨折。单因素分析显示，年龄（P=0.017）、肿瘤大小（P=0.000）、肿瘤数量（P=0.039）、第 5 版 TNM 分期（P=0.023）、门静脉侵犯（P=0.02）和消融反应（P=0.000）差异有统计学意义。多因素分析显示，消融反应（P=0.001）和肿瘤大小（P=0.013）是主要的预后因素。