TACE 联合冷冻消融治疗不可切除性大肝癌的临床分析  

Transarterial chemoembolization combined with cryoablation for unresectable large hepatocellular carcinoma：a controlled study

作　　者：黄琨博 范文哲[1] 张应强[1] 王于[1] 崔伟[1] 李家平[1] 

机构地区：[1]中山大学附属第一医院肿瘤介入科,广州510080

出　　处：《中华医学杂志》2016年第37期2978-2982,共5页National Medical Journal of China

摘　　要：目的：探讨经导管肝动脉化疗栓塞（TACE）联合冷冻消融治疗不可切除性大肝癌疗效与安全性。方法回顾性分析2011年11月至2015年7月中山大学附属第一医院诊治的122例不可切除性大肝癌病例，分为 TACE 联合冷冻消融组（研究组，58例）和单纯 TACE 组（对照组，64例），对比观察其疗效与不良反应。结果研究组和对照组首次治疗的客观有效率为29．3％和10．9％（P ＝0．011），疾病控制率为79．3％和62．5％（P ＝0．042），中位生存期为11．0（95％ CI 7．4～14．6）和5．0个月（95％ CI 4．0～6．0），6、12、18个月的总生存率分别为84．5％、49．5％、26．8％和48．1％、17．8％、11．1％（均P ＜0．01）。无远处转移、巴塞罗那分期 B 期、中性粒细胞与淋巴细胞比值≤5、甲胎蛋白＜400μg／L 及采用联合治疗、首次治疗有效是预后独立保护因素。两组首次治疗后均无严重不良反应及围手术期死亡病例发生。结论TACE 联合冷冻消融治疗不可切除大肝癌近期疗效好，生存期长，严重不良反应发生率低，是一种高效、安全的治疗方案。Objective To evaluate the efficacy and safety of transarterial chemoembolization （TACE） combined with cryoablation in patients with unresectable large hepatocellular carcinoma （HCC）. Methods A total of 122 patients with unresectable large HCC admitted to the First Affiliated Hospital of Sun Yat-sen University between November 2011 and July 2015 were retrospectively involved.The patients were divided into study group （58 patients who underwent TACE combined with cryoablation） and control group （64 patients who underwent TACE alone）.Short-term effect of the initial treatment, long-term effect, prognostic factors for survival and adverse reactions were statistically analyzed.Result There was no statistical difference in general information between two groups.The effective rates of the study and control group were 29.3% and 10.9% （P =0.011）, and the control rates were 79.3% and 62.5% （P =0.042）. The median survival time was 11.0 months （95% CI 7.4 -14.6） for the study group and 5.0 months （95% CI 4.0 -6.0） for the control group, the 6-, 12-, and 18-month overall survival rates for the study and control group were 84.5%, 49.5%, 26.8% and 48.1%, 17.8%, 11.1%, respectively （ all P 〈0.01） .On multivariate analysis, negative distant metastasis, Barcelona Clinic Liver Cancer B-stage, neutrophil-to-lymphocyte ratio ≤5, alpha fetoprotein 〈400 μg/L, combined treatment and effective initial treatment were independent protective factors for survival of patients with large HCC.Conclusions The prognosis of patients with unresectable large HCC is affected by multiple factors.In comparison with TACE alone, TACE combined with cryoablation has advantage in both short-term and long-term effect with low incidence of serious adverse reactions, it is an effective and safe treatment option for patients with unresectable large HCC.

关 键 词：癌  肝细胞 放射学  介入性 冷冻 消融技术 

分 类 号：R735.7[医药卫生—肿瘤]