肝动脉化疗栓塞联合超声/CT双引导的射频消融和碘125粒子植入治疗危险部位肝癌的临床分析  

Transarterial Chemoembolization Plus Ultrasound/CT⁃Guided Radiofrequency Ablation and Iodine⁃125 Seed Implantation for Hepatocellular Carcinoma in High⁃Risk Locations:A Clinical Analysis

作　　者：张桂林 阚雪锋 任衍乔 刘佳韵 熊付 郑传胜[1] ZHANG Guilin;KAN Xuefeng;REN Yanqiao(Department of Radiology,Affiliated Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei Province 430022,P.R.China)

机构地区：[1]华中科技大学同济医学院附属协和医院放射科,武汉430022

出　　处：《临床放射学杂志》2024年第8期1392-1398,共7页Journal of Clinical Radiology

基　　金：国家自然科学基金项目(编号:82372069、82072041);湖北省杰出青年基金项目(编号:2023AFA107)。

摘　　要：目的分析肝动脉化疗栓塞联合超声/CT双引导的射频消融和碘125粒子植入术治疗危险部位肝癌的疗效、并发症及预后影响因素。方法搜集行肝动脉化疗栓塞联合超声/CT双引导的射频消融和碘125粒子植入术治疗危险部位肝细胞癌(≤5 cm)患者资料,统计分析其治疗效果、并发症及患者预后影响因素。结果共纳入56例危险部位肝癌患者,随访17~123个月,33例(58.9%)患者治疗后出现肿瘤复发,其中9例(16.1%)出现局部复发,24例(42.9%)出现肝内远处复发和肝外转移。1~5年肿瘤局部复发率分别为0%、9.1%、13.9%、13.9%、17.5%,1~5年肿瘤总体复发率分别为1.8%、23.6%、37.7%、54.1%、61.6%,单因素和多因素分析显示,肿瘤直径≤3 cm是肿瘤局部和总体复发的保护因素(P=0.009,P<0.001)。患者1~5年肿瘤局部无进展生存率和总体无进展生存率分别为100%、85.6%、72.5%、67.2%、56.0%和98.2%、71.2%、55.8%、39.2%、33.6%,单因素和多因素分析显示,肿瘤直径≤3 cm是患者肿瘤局部无进展生存及总体无进展生存的保护因素(P=0.015,P=0.002)。患者1~5年总体生存率分别为100.0%、94.6%、81.9%、76.7%、64.8%,单因素和多因素分析显示,单个肿瘤病灶、肝癌巴塞罗那分期A期是患者总体生存的保护因素(P=0.016,P=0.009)。所有肝动脉化疗栓塞术、射频消融术、碘125粒子植入术均成功进行,没有出现与治疗相关的严重并发症及死亡。结论对于不可手术切除且直径≤5 cm的危险部位肝癌,肝动脉化疗栓塞联合超声/CT双引导的射频消融和碘125粒子植入治疗是一种理想治疗策略,值得临床推广应用。Objective To analyze the efficacy,complications,and prognosis factors of transarterial chemoembolization(TACE)plus ultrasound/CT⁃guided radiofrequency ablation(RFA)and iodine⁃125(^(125)I)seed implantation(TACE⁃RFA⁃^(125)I)for hepatocellular carcinoma(HCC)in high⁃risk locations.Methods The clinical data of patients with unresectable HCC(≤5 cm)in high⁃risk locations,who received the TACE⁃RFA⁃^(125)I treatments in our hospital,were collected.The RFA and^(125)I seed implantation procedures were performed under ultrasound plus CT guidance.The efficacy,complications,and prognosis factors of these patients were analyzed.Results Fifty⁃sixpatients were included with follow⁃up of 17-123 months and 33 patients(58.9%)experienced the tumor recurrences.Among the tumor recurrence patients,9 patients(16.1%)occurred a local tumor recurrence,and the intrahepatic distant tumor recurrence and extrahepatic tumor metastasis were occurred in 24 patients(42.9%).The 1⁃,2⁃,3⁃,4⁃,and 5⁃year local tumor recurrence rates were 0%,9.1%,13.9%,13.9%,and 17.5%,respectively,and the 1⁃,2⁃,3⁃,4⁃,and 5⁃year overall tumor recurrence rates were 1.8%,23.6%,37.7%,54.1%,and 61.6%,respectively.The univariate and multivariate analyses showed that the tumor size≤3 cm was a protective factor for the local and overall tumor recurrences(P=0.009,P<0.001).The 1⁃,2⁃,3⁃,4⁃,and 5⁃year local tumor progression⁃free survival rates of patients were 100%,85.6%,72.5%,67.2%,and 56.0%,respectively,and the overall tumor progression⁃free survival rates were 98.2%,71.2%,55.8%,39.2%,and 33.6%.The univariate and multivariate analyses showed that the tumor size≤3 cm was a protective factor for the local tumor progression⁃free survival and overall tumor progression⁃free survival time(P=0.015,P=0.002).The 1⁃,2⁃,3⁃,4⁃,and 5⁃year overall survival rates of patients were 100.0%,94.6%,81.9%,76.7%,and 64.8%,respectively.The univariate and multivariate analyses showed that a single tumor lesion and BCLC stage A of H

关 键 词：肝细胞癌 肝动脉化疗栓塞 射频消融 碘125粒子植入 临床分析 

分 类 号：R735.7[医药卫生—肿瘤]