不同时间间隔经肝动脉化疗栓塞联合射频消融治疗中晚期肝癌的疗效及安全性  

Efficacy and safety of different interval between transcatheter arterial chemoembolization and radiofrequency ablation for patients with intermediate and advanced hepatocellular carcinoma

作　　者：陈丽[1,2] 郑丽云[1,2] 方世记[1,2] 陈敏江[2] 应希慧[1,2] 吴发宗[1,2] 赵中伟[1,2] 涂建飞[1,2] 纪建松[1,2] CHEN Li;ZHENG Li-yun;FANG Shi-ji;Chen Min-jiang;YING Xi-hui;WU Fa-zong;ZHAO Zhong-wei;TU Jian-fei;JI Jian-song(Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research of Zhejiang Province,The Fifth Affiliated Hospital of Wenzhou Medical University,Lishui,Zhejiang 323000,China;Interventional Treatment Center,The Fifth Affiliated Hospital of Wenzhou Medical University,Lishui,Zhejiang 323000,China)

机构地区：[1]温州医科大学附属第五医院,浙江省影像诊断与介入微创研究重点实验室,浙江丽水323000 [2]温州医科大学附属第五医院介入诊疗中心,浙江丽水323000

出　　处：《肝胆胰外科杂志》2021年第10期590-595,共6页Journal of Hepatopancreatobiliary Surgery

基　　金：浙江省医药卫生重大科技计划重点项目(WKJ-ZJ-1932);浙江省基础公益研究计划(LGF18H220001);丽水市医学重点学科建设项目(2017ZDXK05);浙江省医药卫生科技计划项目面上项目(201825360);浙江省医药卫生科技计划项目面上项目(2020KY1087)。

摘　　要：目的探讨不同时间间隔经肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)联合射频消融(radiofrequency ablation,RFA)治疗中晚期肝癌的疗效及安全性。方法回顾性分析2012年2月至2017年2月在温州医科大学附属第五医院接受TACE联合RFA治疗的83例经临床或病理诊断中晚期肝癌患者的临床资料。其中男74例,女9例,年龄37~82岁,平均(57.2±9.0)岁。根据TACE和RFA治疗的间隔时间,采用递归分割法将纳入患者分为三组:超短时间隔组(0~5 d,n=14)、短时间隔组(6~22 d,n=35)和长时间隔组(>22 d,n=34)。比较三组的一般临床资料、生存时间(overall survival,OS)、肿瘤无进展生存时间(progressiong-free survival,PFS)及并发症。结果超短时间隔组、短时间隔组和长时间隔组的中位OS分别为31(95%CI 5.4~56.6)个月、28(95%CI 7.2~48.7)个月和23(95%CI 16.4~29.9)个月,三组间无统计学差异(P=0.315)。三组患者的PFS分别为21(95%CI 6.7~35.2)个月、13(95%CI 6.0~19.9)和10(95%CI 7.2~12.8)个月,三组间差异具有统计学意义(P=0.03);短时间隔组(P=0.049)和长时间隔组(P=0.018)的PFS均比超短时间隔组短;长时间隔组PFS短于短时间隔组,但差异无统计学意义(P=0.289)。三组TACE术后发热、腹痛、腹泻、肝功能异常、出血发生率均无统计学差异。三组RFA术后出现血肿形成、皮肤感染,予以对症治疗后缓解,均未见手术相关死亡并发症。结论TACE后5天内行RFA治疗安全可行,比5天后行RFA更有助于延长中晚期肝癌患者的肿瘤无进展时间。Objective To investigate the efficacy and safety of different interval between transcatheter arterial chemoembolization(TACE)and radiofrequency ablation(RFA)for patients with intermediate and advanced hepatocellular carcinoma(HCC).Methods We collected the clinical data of 83 intermediate and advanced HCC patients received sequential treatment of TACE and RFA in the Fifth Affiliated Hospital of Wenzhou Medical University from Feb.2012 to Feb.2017 including 74 males and 9 females,with an average age of(57.2±9.0)years,ranging from 37~82 years.Recursive segmentation was used to select the most appropriate TACE-RFA interval threshold and 83 patients were classified into three groups including ultrashort interval group(less than 5 days,n=14),short interval group(between 6 days and 22 days,n=35)and the long interval group(over 22 days,n=34).The clinical charateristics,survival time(OS),progression free survival time(PFS)and adverse events of the three groups were compared.Results The median OS of ultrashort interval group,short interval group and the long interval group was 31(95%CI 5.4~56.6)months,28(95%CI 7.2~48.7)months and 23(95%CI 16.4~29.9)months,with no statistical difference(P=0.315).The median PFS of the three groups were 21(95%CI 6.7~35.2)months,13(95%CI 6.0~19.9)months and 10(95%CI 7.2~12.8)months,respectively.There was statistical significant difference among the three groups(P=0.03).Compared with the ultrashort time interval group,the median PFS of the short time interval group(P=0.049)and the long time interval group(P=0.018)was significantly shorter.Compared with the short time interval group,median PFS of the long time interval group was shorter,but with no significant difference(P=0.289).There was no significant difference in the incidence of fever,abdominal pain,diarrhea,abnormal liver function and bleeding among the three groups after TACE treatment.Hematoma and skin infection occurred after RFA could be relieved after symptomatic treatment in the three groups.There was no therapy related death among

关 键 词：经导管肝动脉化疗栓塞术 射频消融术 联合疗法 时间间隔 肝癌 

分 类 号：R735.7[医药卫生—肿瘤]