Yuan Peng, Zhang Zhigang, Kuai Jinacg
Department of intervention, Jianhu County People's Hospital, Jianhu, Jiangsu 224700, China.
J BUON. 2019 Jan-Feb;24(1):163-170.
To compare and explore the efficacy and safety of transcatheter arterial chemoembolization (TACE) in combination with radiofrequency ablation (RFA) and microwave ablation (MWA) in the treatment of middle and large primary hepatic carcinoma.
A retrospective analysis was made on 75 patients with middle and large hepatic carcinoma (tumor diameter ≥3 cm) receiving TACE in combination with thermal ablation therapy in our hospital from January 2012 to January 2015, with hepatic function Child-Pugh class A and B. Forty-one cases received TACE+RFA, while 34 cases received TACE+MWA. Patients in both groups were followed up to observe the short-term efficacy, 3-year survival rate, alpha fetoprotein (AFP), indexes of hepatic function and incidence of adverse reactions.
No statistical differences was noted in preoperative general conditions between the two groups of patients. The results showed 28 cases of complete response (CR) and 13 cases of partial response (PR) in the TACE+RFA group, and 29 cases of CR and 5 cases of PR in the TACE+MWA group. The difference in the short-term efficacy between two groups was not significant (p>0.05). With tumor diameter 3-5 cm, there was no statistically significant difference in the efficacy between the two groups (p>0.05), and with tumor diameter over 5 cm, the efficacy in TACE+MWA group was significantly better than that in TACE+RFA group (p=0.041). After treatment, the level of AFP in both groups was decreased in different degrees but without statistical significance (p>0.05). The levels of ALT and AST of hepatic functions in both groups increased after treatment. The postoperative average levels of ALT and AST in the TACE+RFA group were 85.90±49.02 U/L and 113.53±56.54 U/L, respectively, which were significantly lower than those in the TACE+MWA group (138.62±69.04 U/L and 178.03±104.50 U/L; p<0.05). During follow-up, the 1-, 2- and 3-year cumulative survival rates in the TACE+RFA group were 68.30, 36.60 and 14.60%, and those in TACE+MWA group were 79.40, 53.00 and 38.20%. The tumor-free survival rates in the TACE+RFA group were 53.70, 29.30 and 12.20%, and those in TACE+MWA group were 58.80, 38.20 and 29.40%. The difference in survival rate between two groups had no statistical significance (p>0.05). The differences in postoperative adverse reactions and follow-up conditions between two groups were not statistically significant (p>0.05).
The difference in the short-term efficacy between the TACE+RFA and TACE+MWA group in the treatment of middle and large primary hepatic carcinoma had no statistical significance. When the tumor size was over 5 cm, the efficacy in TACE+MWA group was better than that in TACE+RFA group. There were no obvious differences in 1-year cumulative survival rate and tumor-free survival rate between the two groups, but postoperative liver function damage in the TACE+RFA group was lighter than that in TACE+MWA group.
比较并探讨经动脉化疗栓塞术（TACE）联合射频消融（RFA）与微波消融（MWA）治疗中、大型原发性肝癌的疗效及安全性。
回顾性分析2012年1月至2015年1月在我院接受TACE联合热消融治疗的75例中、大型肝癌（肿瘤直径≥3 cm）患者，肝功能为Child-Pugh A级和B级。41例接受TACE+RFA，34例接受TACE+MWA。对两组患者进行随访，观察近期疗效、3年生存率、甲胎蛋白（AFP）、肝功能指标及不良反应发生率。
两组患者术前一般情况无统计学差异。结果显示，TACE+RFA组完全缓解（CR）28例，部分缓解（PR）13例；TACE+MWA组CR 29例，PR 5例。两组近期疗效差异无统计学意义（p>0.05）。肿瘤直径3-5 cm时，两组疗效无统计学差异（p>0.05）；肿瘤直径>5 cm时，TACE+MWA组疗效明显优于TACE+RFA组（p=0.041）。治疗后，两组AFP水平均有不同程度下降，但无统计学意义（p>0.05）。两组肝功能ALT和AST水平治疗后均升高。TACE+RFA组术后ALT和AST平均水平分别为85.90±49.02 U/L和113.53±56.54 U/L，明显低于TACE+MWA组（138.62±69.04 U/L和178.03±104.50 U/L；p<0.05）。随访期间，TACE+RFA组1年、2年和3年累积生存率分别为68.30%、36.60%和14.60%，TACE+MWA组分别为79.40%、53.00%和38.20%。TACE+RFA组无瘤生存率分别为53.70%、29.30%和12.20%，TACE+MWA组分别为58.80%、38.20%和29.40%。两组生存率差异无统计学意义（p>0.05）。两组术后不良反应及随访情况差异无统计学意义（p>0.05）。
TACE+RFA组与TACE+MWA组治疗中、大型原发性肝癌近期疗效差异无统计学意义。肿瘤直径>5 cm时，TACE+MWA组疗效优于TACE+RFA组。两组1年累积生存率和无瘤生存率无明显差异，但TACE+RFA组术后肝功能损害较TACE+MWA组轻。
