TACE联合射频消融及索拉非尼治疗巨块型肝细胞癌的回顾性研究  

The retrospective research of TACE combined with radiofrequency ablation and sorafenib in large hepatocellular carcinoma

作　　者：陈俊伟[1] 赖丽莎 罗骏阳 王皓帆[1] 黄明声[1] 刘雪莲[3] Chen Junwei;Lai Lisha;Luo Junyang;Wang Haofan;Huang Mingsheng;Liu Xuelian(Department of Interventional Radiology,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Radiology,Guangzhou First People's Hospital,School of Medicine,South China University of Technology,Guangzhou 510180,China;The Interventional Operation Room,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院介入科,广州510630 [2]华南理工大学附属第二医院(广州市第一人民医院)放射科,510180 [3]中山大学附属第三医院介入手术室,广州510630

出　　处：《中华肝胆外科杂志》2021年第1期47-51,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：广东省自然科学基金(2018A030313700、2018A030313511)。

摘　　要：目的评估经导管肝动脉栓塞化疗(TACE)联合射频消融及索拉非尼在巨块型肝细胞癌治疗中的安全性及疗效。方法回顾分析2012年1月至2017年12月于中山大学附属第三医院诊治的36例肝细胞癌(直径5~7 cm)患者资料,其中男性33例,女性3例,年龄范围32.0~76.0岁,平均51.8岁。所有患者均接受TACE联合射频消融及索拉非尼综合治疗。TACE后进行疗效评估。射频消融治疗后开始随访,随访不良反应以及生存情况等。Kaplan-Meier法进行生存分析,生存率比较采用log-rank检验。结果所有患者中位TACE次数4次,射频消融次数(1.7±0.7)次,服用索拉非尼(37.7±28.0)个月。索拉非尼相关不良反应手足皮肤反应26例(72.2%)、高血压6例(16.7%)、腹泻22例(61.1%)、脱发17例(47.2%)、口腔溃疡3例(8.3%)及消化道出血1例(2.8%)。36例肝细胞癌患者中位生存时间63.0个月,1、3、5年累积生存率为100.0%、72.7%、52.6%。全程服用索拉菲尼患者(n=21)累积生存率优于补救服用患者(n=15),治疗前甲胎蛋白<200μg/L患者(n=26)累积生存率优于≥200μg/L患者(n=10),TACE有效患者(n=19)累积生存率优于无效患者(n=17),差异均有统计学意义(均P<0.05)。结论巨块型肝细胞癌TACE联合射频消融及索拉非尼的综合治疗安全性和疗效尚可。全程服用索拉非尼、治疗前甲胎蛋白<200μg/L、TACE治疗有效患者生存获益更佳。Objective To investigate the safety and effect of transcatheter arterial chemoembolization(TACE)combined with radiofrequency ablation(RFA)and sorafenib on large hepatocellular carcinoma(HCC)patients treatment.Methods From Jan 2012 to Dec 2017,36 patients(Male:33,Female:3,average age:51.8)with large HCC lesions(5-7 cm)received TACE plus with RFA and sorafenib in the Third Affiliated Hospital of Sun Yat-sen University.Efficacy was evaluated after TACE.Each patient was received follow-up after RFA procedure.The occurrence rate of complications and overall survival(OS)were recorded.Log-rank univariate analysis was used to analyze the OS data.Results The median TACE time was 4,and the RFA time was(1.7±0.7).Mean duration time of sorafenib administration was(37.7±28.8)months.Adverse events of sorafenib:26(72.2%)hand-foot skin reaction,6(16.7%)hypertension,22(61.1%)diarrhea,17(47.2%)alopecia,3(8.3%)oral ulcer and 1(2.8%)gastrointestinal hemorrhage.Median OS was 63.0 months,and 1-year,3-year and 5-year survival rate was 100%,72.7%and 52.6%.The cumulative survival rate of patients taking whole course of sorafenib(n=21)was better than that of patients taking remedial(n=15);the cumulative survival rate of patients with alpha fetal protein(AFP)<200μg/L(n=26)before treatment was better than≥200μg/L(n=10);the cumulative survival rate of patients with good TACE response(n=19)was better than that of patients with no response(n=17),and the differences were statistically significant(all P<0.05).Conclusions TACE plus with RFA and sorafenib are safe and effective for large HCC patients with 5-7 cm lesions and this treatment might improve OS.The whole-course sorafenib,lower base AFP value(<200μg/L)and good TACE response were considered as the good factors for the combination therapy in large HCC patients.

关 键 词：癌 肝细胞 经导管肝动脉栓塞化疗 射频消融 索拉非尼 总生存期 

分 类 号：R735.7[医药卫生—肿瘤]