肝动脉化疗栓塞术序贯微波消融治疗单发直径大于5 cm原发性肝癌的临床研究  

Clinical study of transcatheter arterial chemoembolization sequentially combined with microwave ablation in the treatment of single primary hepatocellular carcinoma with diameter greater than 5 cm

作　　者：安建立[1] 韩孝宇[2] 沙俊峰[1] 牛洪涛[1] 邹子博[1] 武京鹏 董艳超[1] AN Jian-li;HAN Xiao-yu;SHA Jun-feng;NIU Hong-tao;ZOU Zi-bo;WU Jing-peng;DONG Yan-chao(Department of Interventional Treatment;Department of Cardiology, the First Hospital of Qinhuangdao, Hebei 066000, China)

机构地区：[1]秦皇岛市第一医院介入治疗科,河北秦皇岛066000 [2]秦皇岛市第一医院心内科,河北秦皇岛066000

出　　处：《肝胆胰外科杂志》2018年第3期191-196,201,共7页Journal of Hepatopancreatobiliary Surgery

基　　金：秦皇岛市重点研发计划科技支撑项目(201703A076)

摘　　要：目的观察经导管肝动脉化疗栓塞(TACE)联合经皮微波消融(MWA)治疗单发直径大于5 cm原发性肝癌(PHC)的近远期疗效与安全性。方法将2014年7月至2016年12月秦皇岛市第一医院介入治疗科收治的72例大肝癌患者按照随机数字法分为联合组(37例)和对照组(35例),对照组给予TACE治疗,联合组在TACE治疗基础上联合MWA治疗;记录治疗期间药物毒性反应与并发症,治疗1个月判定近期疗效并评估肿瘤负荷变化,随访记录肿瘤无进展生存时间(PFS)和总生存时间(OS)。结果联合组治疗1个月后客观缓解率(ORR,78.4%vs 62.9%)、疾病控制率(DCR,97.3%vs 91.4%)均高于对照组,但差异均无统计学意义(P>0.05);联合组治疗1个月后AFP[(4.82±0.78)ng/mL vs(5.41±0.91)ng/mL]、IGF-II[(5.63±0.90)ng/mL vs(6.08±0.84)ng/mL]以及IGFBP-2[(8.08±0.92)ng/mL vs(8.54±0.96)ng/mL]水平均显著低于对照组(P<0.05)。联合组有效病例行TACE治疗次数显著少于对照组[(1.67±0.52)次vs(2.00±0.66)次,P<0.05];联合组中位PFS、OS分别为11.0个月、16.0个月,对照组分别为7.5个月、11.5个月,两组PFS、OS生存曲线差异均有统计学意义(P<0.05)。联合组1年无疾病进展比例(39.4%vs 10.7%)及1年生存率(69.7%vs 42.9%)、2年生存率(30.3%vs 10.7%)均高于对照组(P<0.05)。联合组肝区疼痛发生率(67.6%vs 40.0%)显著高于对照组(P<0.05),特异性并发症为针道出血与胸腔积液。结论 TACE治疗单发大肝癌基础上序贯MWA能进一步减轻肿瘤负荷,增进TACE疗效,减少TACE治疗次数,能明显延长患者生存期,并发症可控。objective To observe the short-term and long-term effcacy and safety of transcatheter arterial chemoembolization （TACE） sequentially combined with percutaneous microwave ablation （MWA） in the treatment of single primary hepatocellular carcinoma （PHC） with diameter greater than 5 cm. Methods According to the random number, a total of 72 large PHC patients admitted in the First Hospital of inhuangdao from Jul. 2014 to Dec. 2016 were enrolled and divided into combined group （37 cases） and control group （35 cases）. Patients in the control group were treated with TACE, the combined group was added with MWA sequentially, drug toxicities and complications during treatment were recorded, short-term effcacy and tumor load after treatment for 1 month were determined, tumor progression free survival （PFS） and overall survival （OS） during follow-up were noted. Results One month after treatment, objective response rate （ORR, 78.4% vs 62.9%） and disease control rate （DCR, 97.3% vs 91.4%） in the combined group were higher than those in the control group, but the differences were not statistical signifcant （all P〉0.05）; the AFP [（4.82±0.78） ng/mL vs （5.41±0.91） ng/mL], IGF-II [（5.63±0.90） ng/mL vs （6.08±0.84） ng/mL] and IGFBP-2 [（8.08±0.92） ng/mL vs （8.54±0.96） ng/mL in the combined group were signifcantly lower than those in the control group （all P〈0.05）. The TACE frequency for effective cases in combined group were signifcantly lower [（1.67±0.52） vs （2.00±0.66）, P〈0.05] than those in the control group; PFS and OS in combined group and control group were 11.0 and 16.0 months, 7.5 and 11.5 months respectively, There were statistically signifcant differences on PFS and OS survival curves between two groups （P〈0.05）. The 1-year disease-free progression ratio in the combined group （39.4% vs 10.7%）, the 1-year and 2-year survival rate （1year： 69.7% vs 42.9%; 2 year： 30.3% vs 10.7%） were all higher than those in the con

关 键 词：原发性肝癌 经导管肝动脉化疗栓塞术 微波消融 肿瘤标志物 生存分析 并发症 

分 类 号：R735.7[医药卫生—肿瘤]