肝动脉化疗栓塞序贯微波消融治疗初治大肝癌1年内复发的影响因素分析  

Analysis of factors influencing 1 year's recurrence of primary large hepatocellular carcinoma treated with transcatheter arterial chemoembolization and sequential microwave ablation

作　　者：安建立 韩孝宇 沙俊峰 牛洪涛 邹子博 武京鹏 董艳超 An Jianli;Han Xiaoyu;Sha Junfeng;Niu Hongtao;Zou Zibo;Wu Jingpeng;Dong Yanchao(Department of Interventional Treatment;Department of Cardiology,The First Hospital of Qinhuangdao City,Hebei Qinhuangdao 066000,China.)

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

出　　处：《现代肿瘤医学》2018年第18期2887-2892,共6页Journal of Modern Oncology

基　　金：秦皇岛市重点研发计划科技支撑项目(编号:201703A076)

摘　　要：目的:研究并探讨经肝动脉化疗栓塞(TACE)联合微波消融(MWA)治疗大肝癌(含巨块型肝癌)1年内局部复发的影响因素。方法:回顾性分析2013年1月至2016年6月151例行TACE联合WMA治疗的初治大肝癌患者为研究对象,收集患者治疗前后住院资料及随访资料,通过单因素分析及Logistic回归分析探求TACE联合MWA治疗大肝癌1年内局部复发的影响因素。结果:151例患者平均行TACE治疗(1.48±0.43)次、WMA治疗(1.23±0.16)次;联合治疗1个月后,客观缓解率(ORR)、疾病控制率(DCR)分别为80.8%、92.7%;治疗1年内局部复发率为45.7%;复发组与未复发组在瘤体最大直径、合并门静脉癌栓(PVTT)、肝门淋巴结转移、术前甲胎蛋白(AFP)水平、毗邻危险区域、病毒载量、靶向治疗7方面差异显著(P<0.05)。多因素分析显示:瘤体最大直径(OR_(7.5~10 cm)=3.935;OR_(>10 cm)=6.379)、术前合并门静脉癌栓(OR=7.877)、术前AFP≥400 ng/ml(OR=3.411)是TACE联合WMA治疗大肝癌术后1年内复发的独立危险因素(P均<0.05),术后服用索拉菲尼则是复发的独立保护因素(OR=0.119)(P<0.05)。结论:术前AFP≥400 ng/ml、瘤体最大直径超过7.5 cm、合并门静脉癌栓是TACE联合WMA治疗大肝癌短期内复发的预测因子,而术后联合靶向治疗有助于降低短期复发率。Objective： To investigate and explore the influencing factors influencing 1 year＇s local recurrence of primary large or massive hepatocellular carcinoma treated with transcatheter arterial chemoembolization（ TACE） and sequential microwave ablation（ MWA）.Methods： A retrospective analysis was conducted on 151 large PHC patients underwent TACE and WMA therapy from January 2013 to June 2016,patients＇ hospitalization data before and after treatment were collected,the factors on local recurrence with in 1 year were investigated by single factor analysis and Logistic regression analysis.Results： 151 patients were treated with TACE treatment（ 1.48 ± 0.43） times and WMA treatment（ 1.23 ± 0.16） times,the objective response rate（ ORR）,disease control rate（ DCR） after 1 month＇s sequential therapy were 80.8%,92.7% respectively.1 year＇s local recurrence rate was 45.7%.The recurrence group and non recurrence group with significant differences on the maximum tumor diameter,portal vein tumor thrombus（ PVTT）,hepatic portal lymph node metastasis,preoperative AFP level,adjacent to the risk areas,viral load,targeted therapy（ all P 0.05）.Multivariate analysis showed the maximum tumor diameter（ OR_（7.5 ~ 10 cm）= 3.935,OR_（ 10 cm）=6.379）,preoperatively with PVTT（ OR = 7.877）,AFP≥400 ng/ml（ OR = 3.411） were independent risk factor of recurrence within 1 year（ P 0.05）,and sorafenib taking post operation was the independent protective factor for recurrence（ OR = 0.119）（ P 0.05）.Conclusion： Large PHC patients with preoperative AFP≥400 ng/ml,the maximum tumor diameter≥7.5 cm,with PVTT are predictors of short-term recurrence after TACE and sequential WMA therapy,and targeted therapy can help to reduce the short-term recurrence.

关 键 词：原发性大肝癌 经导管肝动脉化疗栓塞术 微波消融 复发 独立影响因素 

分 类 号：R735.7[医药卫生—肿瘤]