射频消融（RFA）联合经导管肝动脉化疗栓塞（TACE）治疗中大型肝癌患者：长期疗效的回顾性分析。

Radiofrequency Ablation (RFA) Combined with Transcatheter Arterial Chemoembolization (TACE) for Patients with Medium-to-Large Hepatocellular Carcinoma: A Retrospective Analysis of Long-Term Outcome.

机构信息

Department of Radiology, Lishui Central Hospital/Key Laboratory of Imaging Diagnosis and Minimally Invasive Interventional Research of Zhejiang, Lishui, Zhejiang, China (mainland).

Department of Radiology, Qingtian County People's Hospital of Lishui City, Lishui, Zhejiang, China (mainland).

出版信息

Med Sci Monit. 2020 Jul 15;26:e923263. doi: 10.12659/MSM.923263.

BACKGROUND The aim of this study was to investigate the prognostic value of radiofrequency ablation (RFA) plus transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) patients with tumor size ranging from 3.0 to 10.0 cm. MATERIAL AND METHODS We retrospectively analyzed data on 201 patients with medium-to-large HCC. According to treatment procedure, the patients were divided into the TACE group (n=124) and the TACE+RFA group (n=77). We recorded data on patient safety, subcapsular hepatic hematoma, large amount of ascites, liver abscess, gallbladder injury, and local skin infection. The overall survival (OS) and progression-free survival (PFS) in the 2 groups were analyzed and compared between groups. RESULTS The median PFS was 4.00 months (3.00-5.00 months) in the TACE group and 9.13 months (6.64-11.62 months) in the TACE+RFA group (P<0.001). Median OS was 12.00 months (8.88-15.13 months) in the TACE group and 27.57 months (20.06-35.08 months) in the TACE+RFA group (P<0.001). In the TACE+RFA group, multivariate Cox regression analysis showed that tumor size ≤5 cm) (HR: 1.952, 95% CI: 1.213-3.143, P=0.006), hepatitis B (HR: 2.323, 95% CI: 1.096-4.923, P=0.028), TACE times (1 or >1) (HR: 1.867, 95% CI: 1.156-3.013, P=0.011), alpha-fetoprotein (AFP) level >200 ng/ml (HR: 2.426, 95% CI: 1.533-3.839, P<0.001), and AST level >40 U/L (HR: 1.946, 95% CI: 1.196-3.166, P=0.007) were independent prognostic factors for overall survival. CONCLUSIONS Combination therapy of TACE with RFA is a safe and effective treatment for patients with medium-to-large HCC, with the long-term beneficial effect of retarding tumor progression and improving PFS and OS.

背景

本研究旨在探讨射频消融（RFA）联合经导管动脉化疗栓塞（TACE）治疗直径 3.0-10.0cm 肝癌患者的预后价值。

材料与方法

回顾性分析 201 例中大型肝癌患者资料。根据治疗方案，患者分为 TACE 组（n=124）和 TACE+RFA 组（n=77）。记录患者安全性、包膜下肝血肿、大量腹水、肝脓肿、胆囊损伤和局部皮肤感染等情况。分析并比较两组患者的总生存期（OS）和无进展生存期（PFS）。

结果

TACE 组中位 PFS 为 4.00 个月（3.00-5.00 个月），TACE+RFA 组中位 PFS 为 9.13 个月（6.64-11.62 个月）（P<0.001）。TACE 组中位 OS 为 12.00 个月（8.88-15.13 个月），TACE+RFA 组中位 OS 为 27.57 个月（20.06-35.08 个月）（P<0.001）。在 TACE+RFA 组中，多因素 Cox 回归分析显示肿瘤直径≤5cm（HR：1.952，95%CI：1.213-3.143，P=0.006）、乙型肝炎（HR：2.323，95%CI：1.096-4.923，P=0.028）、TACE 次数（1 次或>1 次）（HR：1.867，95%CI：1.156-3.013，P=0.011）、甲胎蛋白（AFP）水平>200ng/ml（HR：2.426，95%CI：1.533-3.839，P<0.001）和 AST 水平>40U/L（HR：1.946，95%CI：1.196-3.166，P=0.007）是总生存期的独立预后因素。