经导管动脉化疗栓塞联合射频消融与单纯经导管动脉化疗栓塞治疗不可切除肝细胞癌患者的生活质量比较。
Quality of Life after Transcatheter Arterial Chemoembolization Combined with Radiofrequency Ablation in Patients with Unresectable Hepatocellular Carcinoma Compared with Transcatheter Arterial Chemoembolization alone.
机构信息
Department of Endemic Medicine and Gastroenterology, Faculty of Medicine, Minia University, Egypt.
Department of Radiology Medicine and Gastroenterology, Faculty of Medicine, Minia University, Egypt.
出版信息
Asian Pac J Cancer Prev. 2021 Apr 1;22(4):1255-1261. doi: 10.31557/APJCP.2021.22.4.1255.
AIM
The aim of this study was to assess quality of life (QoL) in patients with unresectable hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) compared to TACE plus radiofrequency ablation (RFA) done at the same sitting, and to assess tumor therapy response after these 2 palliative interventions.
METHODS
73 patients with unresectable HCC (BCLC-B) were included. Patients with tumor ≤ 5 cm were subjected to TACE (N = 45) while patients with tumors > 5 cm were subjected to TACE followed immediately by RFA (N = 28). QoL was evaluated with two validated questionnaires (EORTC QLQ-30 and EORTC HCC18). These questionnaires were filled out before intervention, 2 weeks and 2 months after intervention. Pre/post interventional changes were analyzed. The modified response evaluation criteria in solid tumor (mRECIST) were employed for the evaluation of therapeutic efficacy.
RESULTS
Baseline global health status/QoL was significantly higher in TACE group (64.1%) compared to TACE-RFA group (51.2%). Two weeks after intervention: the absolute decrease in global health state was higher in TACE-RFA (- 12.1%) compared to TACE (- 6.3%, p = 0.411). Less impairment was found in TACE group compared to TACE-RFA group for physical/social functioning, fatigue and pain but it was statistically insignificant. Two months after intervention; TACE-RFA group showed significant improvement in global health score, social and physical functioning scores, as well as significant improvement in pain and fatigue compared to TACE group. The therapeutic efficacy of TACE-RFA was better than TACE alone: complete remission, partial remission, stable disease and progressive disease were 17.9%, 32.1%, 42.9% and 7.1% Vs11.1%, 22.2%, 48.9% and 17.8%, respectively).
CONCLUSION
Neither TACE nor TACE-RFA showed a significant decrease in QoL in patients with unresectable HCC two weeks after intervention. However, two months after intervention; TACE-RFA showed significant improvement in global health score compared to TACE monotherapy. TACE-RFA appeared safe, effective and more favorable than TACE monotherapy.
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目的
本研究旨在评估经导管动脉化疗栓塞术（TACE）与 TACE 联合射频消融术（RFA）治疗不可切除肝细胞癌（HCC）患者的生活质量（QoL），并评估这两种姑息性介入治疗后的肿瘤治疗反应。
方法：纳入 73 例不可切除 HCC（BCLC-B）患者。肿瘤≤5cm 的患者接受 TACE（N=45），肿瘤＞5cm 的患者接受 TACE 后立即行 RFA（N=28）。采用两个经过验证的问卷（EORTC QLQ-30 和 EORTC HCC18）评估 QoL。这些问卷在干预前、干预后 2 周和 2 个月填写。分析干预前后的变化。采用改良实体瘤反应评价标准（mRECIST）评估治疗效果。
结果：TACE 组（64.1%）的基线全球健康状况/QoL 明显高于 TACE-RFA 组（51.2%）。干预后 2 周：TACE-RFA 组（-12.1%）的全球健康状态绝对下降幅度明显高于 TACE 组（-6.3%，p=0.411）。TACE 组的身体/社交功能、疲劳和疼痛的损害程度低于 TACE-RFA 组，但无统计学意义。干预后 2 个月：TACE-RFA 组的全球健康评分、社会和身体功能评分以及疼痛和疲劳均有显著改善，明显优于 TACE 组。TACE-RFA 的治疗效果优于 TACE 单独治疗：完全缓解、部分缓解、稳定疾病和进展性疾病分别为 17.9%、32.1%、42.9%和 7.1%与 11.1%、22.2%、48.9%和 17.8%）。
结论：TACE 和 TACE-RFA 治疗不可切除 HCC 患者的生活质量在干预后 2 周内均无明显下降。然而，干预后 2 个月：TACE-RFA 组的全球健康评分明显高于 TACE 单药治疗。TACE-RFA 似乎比 TACE 单药治疗更安全、有效且更有利。
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