大肝癌的综合性微创介入治疗研究及预后分析  

Analysis of minimal invasive interventional therapy and prognosis in large hepatocellular carcinoma

作　　者：冀春亮[1] 陈正光[1] 

机构地区：[1]北京中医药大学东直门医院放射科,北京100700

出　　处：《放射学实践》2018年第3期304-310,共7页Radiologic Practice

摘　　要：目的:分析经肝动脉灌注化疗栓塞术(TACE)和TACE+射频消融(RFA)两种治疗方案对原发性大肝癌的疗效,并分析大肝癌的预后影响因素,旨在探索出一套规范化的介入治疗模式,提高大肝癌的治疗效果,并为大肝癌的预后评估提供理论依据。方法:回顾性分析50例行TACE及TACE+RFA介入方案治疗的原发性大肝癌患者的病例资料,记录患者的一般资料、治疗情况、肿瘤情况、检查情况等,并观察患者病情的变化情况。对影响肝癌治疗及预后的相关因素行Cox回归分析。结果:TACE+RFA组肿瘤有效缩小率为70%,TACE组肿瘤有效缩小率为33.33%,差异有统计学意义(P<0.05)。TACE组和TACE+RFA组治疗前后AFP差值差异有统计学意义(Z=-2.020,P<0.05)。TACE组和TACE+RFA组术后6个月、1年及2年的生存率分别为83.33%、56.67%、30.00%和90.00%、75.00%、55.00%,其中位生存期分别为13个月和17个月,两组生存率差异有统计学意义(χ~2=4.059,P<0.05)。Cox回归多因素分析表明,HbsAg(+)、治疗前主瘤直径、治疗方式及治疗后肿瘤有效缩小率与预后显著相关。结论:TACE+RFA疗效显著优于单纯TACE。HbsAg(+)、治疗前主瘤直径、治疗方式及治疗后肿瘤缩小率是影响大肝癌介入治疗预后的重要因素。Objective： To analyze the efficacy of TACE （transcatheter arterial chemoembolazi- tion） and TACE＋RFA （radiofrequency ablation） in the treatment of primary large hepatocellular car- cinoma （HCC） and the prognostic factors,in order to explore an approach for a standardized interven- tional treatment,as well as to improve the therapeutic effect of HCC and to provide a theoretical basis for the evaluation of prognosis. Methods： The clinical materials including general information, treat- ment approach,state of tumor in 50 cases with primary large HCC undertook TACE or TACE＋RFA were retrospectively analyzed. The change of state of illness was studied. Cox regression analysis was used to analyze the related factors that influence the treatment and prognosis of HCC. Results： The tumor reduction rate was 70% in the TACE＋RFA group,which was 33.33~/oo in the TACE group, with statistically significant difference （P〈0.05）. The AFP value before and after treatment also had statistic significant difference in these two groups （Z=-2. 020 ,P〈0.05）. The survival rate of TACE group and TACE＋RFA group after six m,ly and 2y were 83. 33%,56. 67%,30% and 90%,75%, 55% respectively,the median survival time was 13 mand 17m respectively,with significant difference （X2：4. 059, P〈0.05）. Multivariate analysis with Cox regression showed that HbsAg （＋）, diameter of major tumor, treatment approach and reduction rate after therapy were significantly related with prognosis. Conclusion ： In large hepatocellular carcinoma, the treatment efficacy of TACE＋ RFA group was better than that of TACE group, HbsAg （＋）, major diameter of tumor before treatment, thera- peutic approach and tumor reduction after treatment are important factors influencing the prognosis with using interventional therapy.

关 键 词：肝肿瘤 经肝动脉灌注化疗栓塞术 射频消融 COX回归分析 

分 类 号：R735.7[医药卫生—肿瘤]