短时间隔经导管化疗栓塞联合射频消融术序贯治疗中晚期肝癌的疗效及安全性分析  

Efficacy and safety of short-term interval transcatheter arterial chemoembolization and radiofrequency ablation sequential therapy for advanced hepatocellular carcinoma

作　　者：方世记 郑丽云 吴发宗 宋晶晶[1] 范晓希[1] 赵中伟[1] 纪建松[1] Fang Shiji;Zheng Liyun;Wu Fazong;Song Jingjing;Fan Xiaoxi;Zhao Zhongwei;Ji Jiansong(Interventional Diagnosis and Treatment Center,Central Hospital of Lishui,Lishui 323000,China)

机构地区：[1]浙江省丽水市中心医院介入诊疗中心,323000

出　　处：《中华放射学杂志》2020年第6期582-586,共5页Chinese Journal of Radiology

基　　金：国家重点研发计划政府间国际科技创新合作重点专项(2018YFE0126900);国家自然科学基金(81803778);浙江省自然科学基金/探索项目Q(LQ20H160055)。

摘　　要：目的探索短时间隔经导管动脉化疗栓塞术(TACE)联合射频消融术(RFA)序贯治疗中晚期肝癌的疗效和安全性。方法回顾性分析2010年3月至2019年1月丽水市中心医院117例中晚期肝癌患者的临床资料,所有患者均行TACE和RFA治疗,根据TACE治疗后行RFA治疗的时间间隔的长短,分为短时间间隔组(间隔时间≤7 d,61例)和长时间间隔组(间隔时间>7 d,56例),观察其疗效。采用Wilcoxon检验比较2组患者的治疗有效率,Kaplan-Meier生存曲线计算生存(OS)时间和无进展生存(PFS)时间和生存率,Cox多因素分析TACE-RFA序贯治疗中晚期肝癌疗效的危险因素,χ²检验比较2组术后不良反应的差异。结果短时间间隔组的有效率(72.1%,43/61)高于长时间间隔组(41.1%,23/56),差异有统计学意义(Z=-2.50,P=0.01)。短时间间隔组患者的中位PFS时间(14.9个月)长于长时间间隔组(9.1个月),2组生存曲线差异有统计学意义(χ²=5.90,P=0.01);短时间间隔组的中位OS时间(34.7个月)长于长时间间隔组(20.3个月),2组生存曲线差异有统计学意义(χ²=6.60,P=0.01)。Cox多因素分析显示肿瘤大小[风险比(HR)=2.42,P<0.01]、肝硬化(HR=2.04,P<0.01)、时间间隔(HR=0.44,P<0.01)、谷草转氨酶(HR=1.71,P=0.03)是中晚期肝癌患者预后的独立影响因素。2组患者术后不良反应差异均无统计学意义(P>0.05)。结论短时间隔TACE-RFA序贯治疗是安全、有效的治疗中晚期肝癌的方案,可改善患者预后。Objective To investigate the efficacy and safety of short-term transcatheter arterial chemoembolization(TACE)-radiofrequency ablation(RFA)sequential therapy for advanced hepatocellular carcinoma(HCC).Methods The clinical data of 117 patients with advanced HCC enrolled in the Central Hospital of Lishui from March 2010 to January 2019 were retrospectively analyzed.All patients received TACE and RFA sequential therapy.The patients were divided into 2 groups including short interval group(interval≤7 d,61 cases)and long interval group(interval>7 d,56 cases)according to interval between TACE and RFA.The difference of response rate was analyzed by Wilcoxon test.Kaplan-Meier survival curve was used to calculate the overall survival(OS)time and progression free survival(PFS)time.The risk factors of TACE-RFA sequential therapy were tested using Cox multivariate analysis.The complications in the two groups were compared usingχ2 test.Results The response rate in the short interval group(72.1%,43/61)was significantly higher than that in the long interval group(41.1%,23/56)with significant difference(Z=-2.50,P=0.01).The median PFS in the short interval group(14.9 months)was longer than that in the long interval group(9.1 months).The difference of PFS survival curve between the 2 groups was statistically significant(χ²=5.90,P=0.01).The median OS in the short interval group(34.7 months)was longer than that in the long interval group(20.3 months).The difference of OS survival curve between the 2 groups was statistically significant(χ²=6.60,P=0.01).Cox multivariate analysis showed that tumor size[hazard ratio(HR)=2.42,P<0.01],cirrhosis(HR=2.04,P<0.01),interval(HR=0.44,P<0.01),aspartate aminotransferase(HR=1.71,P=0.03)were the independent risk factors for advanced HCC.There were no significant differences in the complication incidence between the 2 groups(P>0.05).Conclusion Short-term interval TACE-RFA sequential therapy as a protective factor is efficient and safe for advanced HCC treatment.

关 键 词：癌 肝细胞 化学栓塞 治疗性 导管消融术 短时间间隔 

分 类 号：R735.7[医药卫生—肿瘤]