TACE联合超声引导经皮微波消融治疗术后复发性肝细胞癌的临床研究  

Clinical research on combined TACE and ultrasound guided microwave ablation for recurrent hepatocellular carcinoma after initial surgery

作　　者：姜婷婷 牟培源 段伟宏 刘全达 白媛媛 雷磊 JIANG Tingting;MU Peiyuan;DUAN Weihong;LIU Quanda;BAI Yuanyuan;LEI Lei(Postgraduate Training Base in PLA Rocket Force Characteristic Medical Center, Jinzhou Medical University, Jinzhou 121000, Liaoning, China;Department of Hepatological Institute, The PLA Rocket Force Characteristic Medical Center, Beijing 100088, China)

机构地区：[1]锦州医科大学火箭军特色医学中心联合培养基地肝胆外科,辽宁锦州121000 [2]中国人民解放军火箭军特色医学中心肝胆外科,北京100088

出　　处：《暨南大学学报（自然科学与医学版）》2022年第3期284-292,共9页Journal of Jinan University(Natural Science & Medicine Edition)

基　　金：国家重点研发计划项目(2017YFC0110401)。

摘　　要：目的:比较肝动脉化疗栓塞(TACE)联合超声引导下经皮微波消融(TACE-MWA)与单独TACE在肝癌根治性切除后复发性肝癌(RHCC)中的疗效。方法:回顾性研究2014年1月至2017年12月我院107例RHCC患者的临床资料,其中TACE组60例,TACE-MWA组47例。比较两组患者的总生存期、无进展生存期,并分析预后影响因素。为平衡两组间的协变量差异,使用1∶1倾向性得分匹配(PSM)。结果:PSM前,TACE组和TACE-MWA组5年生存率分别为17.7%,35%(P=0.027);5年无进展生存率分别为13.4%,28.9%(P=0.029)。PSM后,TACE组和TACE-MWA组5年生存率分别为15.3%,39.5%(P=0.038);5年无进展生存率分别为12.6%,31.2%(P=0.049)。在亚组分析中,肿瘤复发时间(TTR)≤1年,TACE组和TACE-MWA组5年生存率分别为12.8%,16.7%(P=0.959);TTR>1年,TACE组和TACE-MWA组5年生存率分别为21.3%,46.6%(P=0.020)。经Cox回归分析后,肿瘤分化程度、初次肝切除后微血管侵犯(MVI)和复发肿瘤直径>3 cm是影响RHCC患者总生存期和无进展生存期的独立危险因素(P<0.05)。结论:对于TTR>1年的RHCC患者,TACE-MWA疗效优于TACE。肿瘤分化程度低、MVI阳性、复发肿瘤直径>3 cm,影响RHCC患者远期疗效。Objective:To compare and evaluate the efficacy of transcatheter arterial chemoembolization combined with ultrasound guided percutaneous microwave ablation(TACE-MWA)and transcatheter arterial chemoembolization(TACE)alone in the treatment of recurrent hepatocellular carcinoma(RHCC)after radical resection of liver cancer.Methods:From January 2014 to December 2017,107 patients with RHCC who underwent TACE alone(n=60)or TACE-MWA(n=47)after initial surgery in our hospital,were studied retrospectively.Overall survival(OS)and progression-free survival(PFS)were compared and the prognostic factors were analyzed.To balance the covariate differences between the two groups,1∶1 Propensity score match(PSM)was performed.Results:Before PSM,the 5-year OS rates were 17.7%and 35%(P=0.027),and the 5-year PFS rates were 13.4%and 28.9%(P=0.029)for TACE alone and TACE-MWA groups,respectively.After PSM,the 5-year OS rates were 15.3%and 39.5%(P=0.038),and the 5-year PFS rates were 12.6%and 31.2%(P=0.049)for the groups of TACE alone and TACE-MWA,respectively.The analysis of subgroup results showed that the 5-year OS rates were 12.8%and 16.7%(P=0.959)for the groups of TACE and TACE-MWA when time to recurrence(TTR)≤1 year;and 21.3%and 46.6%(P=0.020)when TTR>1 year.Cox regression analysis indicated that the degree of tumor differentiation,microvascular invasion(MVI)after primary hepatectomy and recurrent tumor diameter>3 cm were independent risk factor affecting OS and PFS(both P<0.05)of patients with RHCC.Conclusion:For patients with RHCC,the efficacy of TACE-MWA is superior to TACE alone when TTR>1 year.Moreover,poorly differentiated,MVI positive and tumor diameter>3 cm are not conducive to long-term curative effect.

关 键 词：复发性肝癌 肝动脉化疗栓塞 微波消融 倾向性匹配分析 总生存期 无进展生存期 

分 类 号：R735.7[医药卫生—肿瘤] R730.5[医药卫生—临床医学]