[肝动脉化疗栓塞术联合CT引导下精准微波消融治疗原发性肝癌的疗效评估与探讨]

[Efficacy evaluation and exploration of TACE combined with CT-guided precision microwave ablation treatment for primary liver cancer].

作者信息

Zhao P, Zheng J S, Zhang H H, Yuan C W, Cui S C, Du N, Zhao L Y

机构信息

Center of Minimally Invasive Interventional Therapy, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China.

出版信息

Zhonghua Zhong Liu Za Zhi. 2016 Feb;38(2):138-45. doi: 10.3760/cma.j.issn.0253-3766.2016.02.012.

DOI:10.3760/cma.j.issn.0253-3766.2016.02.012

PMID:26899335

Abstract

OBJECTIVE

To analyze the clinical therapeutic efficacy of transcatheter arterial chemoembolization combined with CT-guided percutaneous precision microwave ablation for the treatment of primary liver cancer and its influencing factors.

METHODS

A total of 126 patients with primary liver cancer were treated by transcatheter arterial chemoembolization combined with CT-guided percutaneous precision microwave ablation from Mar 2010 to Oct 2014 in our center. The treatment effect, postoperative complications and recurrence rates were observed, and the factors related to recurrence and survival time were analyzed.

RESULTS

All 126 primary liver cancer patients with 201 tumors were ablated for 177 times, and 113 cases with 185 tumors were completed ablated, the complete ablation rate was 92.0%. In all patients, 4 cases had serious complications, the incidence rate was 3.2%. 37 cases had recurrence, with a recurrence rate of 29.4%. All patients were followed up for 10 to 65 months, 17 patients died, and the 1-, 2-, and 3-year cumulative survival rates were 95.2%, 88.1%, and 84.1%, respectively, and the 1-, 2-, and 3-year progression-free-survival rates were 81.5%, 62.7% and 49.2%, respectively .Univariate analysis showed that preoperative AFP level, Child-Pugh score, BCLC stage and the largest tumor size were associated with the survival of patients who received TACE combined with CT-guided precision MWA, and the preoperative AFP level, internal medicine therapy, tumor number and the largest tumor size were associated with the progression-free-survival after the treatment (P<0.05). Multivariate analysis showed that Child-Pugh score and BCLC stage were independent factors affecting the survival of patients with primary liver cancer patients treated with TACE combined with CT guided percutaneous MWA, and the tumor number and the maximum tumor size were independent factors affecting the progression-free-survival of the patients (P<0.05).

CONCLUSION

TACE combined with CT-guided percutaneous precision microwave ablation therapy for primary liver cancer has reliable safety and efficacy.

摘要

目的

分析经导管动脉化疗栓塞术联合CT引导下经皮精准微波消融术治疗原发性肝癌的临床疗效及其影响因素。

方法

2010年3月至2014年10月，本中心共126例原发性肝癌患者接受经导管动脉化疗栓塞术联合CT引导下经皮精准微波消融术治疗。观察治疗效果、术后并发症及复发率，并分析与复发及生存时间相关的因素。

结果

126例原发性肝癌患者共201个肿瘤，行消融治疗177次，113例患者的185个肿瘤完成消融，完全消融率为92.0%。所有患者中，4例出现严重并发症，发生率为3.2%。37例复发，复发率为29.4%。所有患者随访10至65个月，17例死亡，1、2、3年累积生存率分别为95.2%、88.1%、84.1%，1、2、3年无进展生存率分别为81.5%、62.7%、49.2%。单因素分析显示，术前甲胎蛋白水平、Child-Pugh评分、BCLC分期及最大肿瘤直径与接受TACE联合CT引导下精准MWA治疗患者的生存相关，术前甲胎蛋白水平、内科治疗、肿瘤数量及最大肿瘤直径与治疗后的无进展生存相关（P<0.05）。多因素分析显示，Child-Pugh评分和BCLC分期是影响TACE联合CT引导下经皮MWA治疗原发性肝癌患者生存的独立因素，肿瘤数量和最大肿瘤直径是影响患者无进展生存的独立因素（P<0.05）。