射频消融联合经导管肝动脉栓塞化疗治疗肝癌疗效分析  

Effectiveness of radiofrequency ablation combined with transcatheter arterial chemoembolization for hepatocellular carcinoma

作　　者：高恒军[1] 梁惠宏[1] 陈敏山[1] 彭振维[1] 张耀军[1] 黎鹏[1] 庞雄昊[1] 张亚奇[1] 李锦清[1] 

机构地区：[1]中山大学肿瘤防治中心肝胆外科、华南肿瘤学国家重点实验室,广州 510060

出　　处：《中华医学杂志》2008年第36期2529-2532,共4页National Medical Journal of China

基　　金：广东省科委社会攻关基金资助项目（2006 B36002008）

摘　　要：目的分析射频消融（RFA）联合经导管肝动脉栓塞化疗（TACE）治疗原发性肝癌的近期和远期疗效。方法回顾性分析中山大学肿瘤防治中心肝胆外科2000年9月至2007年8月临床诊断为原发性肝细胞性肝癌114例，并行射频消融联合导管肝动脉栓塞化疗，对其进行生存分析。结果全部病例1、2、3、4、5年总体生存率分别为90．4％、82．6％、73．2％、63．5％、49．1％、1、2、3、4、5年肿瘤无进展生存率分别为：77．1％、64．6％、54．6％、46．8％、36．4％。其中，病灶最大直径≤5cm和5．1～7cm的1、2、3、4、5年生存率分别为95．5％、84．6％、73．1％、61．5％、50．6％及80．2％、64．9％、56．3％、45．3％、39．5％（P=0．041），单个病灶和多个（不多于3个病灶）病灶的1、2、3、4、5年生存率分别为95．8％、89．1％、78．1％、67．1％、56．7％及80．0％、60．6％、46．6％、33．4％、21．5％（P=0．001）。结论RFA联合TACE是一种治疗肝癌的有效方法，直径≤5cm、单个病灶的肝癌效果明显好于直径5．1～7cm、多个病灶的肝癌。白蛋白水平、甲胎蛋白水平、肿瘤病灶边界是否清楚及病灶数目是影响联合治疗疗效的预后因素。Objective To analyze the short-term and long-term effectiveness of radiofrequency ablation （RFA） combined with transcatheter arterial chemoembolization （TACE） in the treatment of hepatocellular carcinoma （HCC）. Methods The clinical data of 114 HCC patients, 104 males and 10 females, aged 55 （30 -81 ）, treated by RFA combined with TACE and followed up for 20 （1 -82） months were analyzed. Results Complete necrosis was achieved in 101 patients （ 88.6% ）. 10 patients showed incomplete necrosis and 3 patients showed new neoplasm, and they all underwent repeated RFA or TACE. No therapy-relative death was found. The overall 1-, 2-, 3-, 4-, and 5-year survival rates were 90. 4%, 82. 6%, 73. 2% , 63.5% , and 49. 1% respectively. The 1-, 2-, 3-, 4-, and 5-year tumor progression-free survival rates were 77. 1% , 64. 6% , 54. 6% , 46. 8% , and 36. 4% respectively. The overall 1-, 2-, 3-, 4-, and 5-year survival rates for the tumors with the size ≤5 cm and the tumors with the size of 5.1 -7 cm were 95.5%, 84. 6%, 73. 1%, 61.5%, and 50. 6% and 80. 2%, 64. 9%, 56. 3%, 45. 3%, and 39. 5% respectively （P = 0. 041 ）. The overall 1-, 2-, 3-, 4-, and 5-year survival rates for the solitary tumor and multiple tumors（no more than 3 tumors） were 95.8% , 89.1% , 78.1% , 67.1% , and 56. 7% and 80. 0%, 60. 6%, 46.6%, 33.4% ,and 21.5% respectively （P =0. 001 ）. The levels of albumin and α-fetoprotein, and boundary and number of tumors were proved to be independent risk factors of survival. Conclusion RFA combined with TACE is an effective treatment for HCC with satisfactory short-term and long-term effects, especially for the patients with tumor of the size of 5.1 - 7 cm or multiple lesions.

关 键 词：肝细胞癌 射频消融术 放射学 介入性 疗效 

分 类 号：R686[医药卫生—骨科学]