TACE联合射频消融与单独射频消融治疗结节型肝癌临床对比分析  

Comparative Analysis of RFA Alone and RFA Plus TACE in the Treatment of Hepatocellular Carcinoma

作　　者：李金鹏[1,2] 陈华[1,2] 石丛丛[3] 宋金龙[1,2] 卜文哲[1,2] 韩明笑天[1,2] 

机构地区：[1]山东省肿瘤医院外九科 [2]山东省医学科学院,济南250117 [3]山东省精神卫生中心六病房,济南250014

出　　处：《临床放射学杂志》2013年第8期1159-1163,共5页Journal of Clinical Radiology

摘　　要：目的评价单独射频消融(RFA)与肝动脉化疗栓塞术(TACE)联合RFA两种方法治疗结节型肝癌的有效性。方法 143例肝内病变直径为3～5 cm肝癌患者(RFA组76例,TACE+RFA组67例),通过CT扫描和AFP水平测定进行随访。两组病例的局部肿瘤进展率分析采用Kaplan-Meier法,以Cox回归模型进行多元预后因素分析。结果 143例经RFA或TACE+RFA治疗后平均随访42个月(2～127个月),RFA组有73%的患者出现局部肿瘤进展,TACE+RFA组有38%的患者出现局部肿瘤进展;RFA组1、3、5、7年局部肿瘤进展率分别为48%、74%、87%和90%,TACE+RFA组1、3、5、7年局部肿瘤进展率分别为8%、38%、53%和68%,两组的差异具有统计学意义(P<0.01)。RFA组有2例(2.6%)治疗后出现腹腔出血和肝段梗死等并发症;TACE+RFA无一例发生相关并发症。多因素分析表明,治疗方式(RR,0.677;P=0.041)、Child-Pugh分级(RR,1.504;P=0.04)是影响患者生存率的独立危险因素。结论 TACE+RFA治疗结节型肝细胞癌较单独应用RFA治疗安全有效,可以更好地控制肝内病变;同时多因素分析表明,治疗方式和Child-Pugh分级是影响患者生存率的独立危险因素。Objective To evaluate the effectivity of transarterial chemoembolization （TACE） combined with radiofre quency ablation （RFA） in treatment of medium sized （3.0 5.0 cm） hepatocellular carcinoma （HCC）, compared with RFA. Methods From March 2003 to April 2011,67 patients with medium sized HCC were treated with TACE combined RFA, and 76 patients were treated with RFA alone. Follow up （mean = 42 months;range of 2 127 months） was per formed by computed tomography and alphafetoprotein（AFP） assay. Local tumor progression rate was calculated using the KaplanMeier method and compared using the logrank test. Results Local tumor progression was observed in 38% of pa tients treated with TACE combined RFA, and 73% of patients treated with RFA alone. The 1,3,5 and 7 year local tumor progression rate of TACE ＋ RFA group （8% ,38% ,53% and 68%, respectively） were significantly lower than that of RFA group （48% ,74% ,87% and 90%, respectively; P =0.001 ）. The rates of major complications were 0% for TA CE ＋ RFA group and 2.6% for RFA group. Multivariate analysis showed that treatment allocation （ RR, 0. 677 ; P = 0. 041 ） and ChildPugh class （ RR, 1. 504 ; P = 0.04） were significant independent factors associated with patient surviv al. Conclusion The combination of TACE and RFA is safe and provides better local tumor control than RFA alone for the treatment of patients with mediumsized HCC. Multivariate analysis showed that treatment allocation and ChildPugh class were signi cant independent factors associated with patient survival.

关 键 词：癌 肝细胞 射频消融术 肝动脉化疗栓塞术 局部肿瘤进展率 

分 类 号：R735.7[医药卫生—肿瘤]