TACE与TACE联合RFA治疗中晚期原发性肝癌167例临床对比分析

Comparative analysis of TACE alone or plus RFA in the treatment of 167 cases of intermediate and advanced staged primary hepatocellular carcinoma

目的 分析比较单独应用经导管动脉内化疗栓塞（TACE）与TACE联合射频消融（RFA）治疗中晚期原发性肝细胞癌（HCC）的临床疗效及生存状况.方法 回顾性研究2000年1月至2006年12月中山大学肿瘤防治中心影像与微创介入治疗中心467例接受TACE及RFA治疗的中晚期原发性肝癌患者,其中167例具有完整的临床治疗过程及随访资料,共87例接受TACE治疗（TACE组）,80例接受TACE联合RFA治疗（TACE-RFA组）,两组患者的一般临床资料及肿瘤情况差异无统计学意义,比较其生存状况并予以分层分析.结果 167例患者经TACE或TACE联合RFA治疗后共随访42个月（1～89个月）,TACE组至疾病进展时间（TTP）平均为3.6个月,中位生存期为13个月,1、3、5年生存率分别为52.9%、11.5%和4.6%.TACE-RFA组80例患者TTP平均为10.8个月,中位生存期为30个月,1、3、5年生存率分别为85.0%、45.0%和11.3%.TACE组与TACE-RFA组在TTP、生存状况方面差异均有统计学意义（均P＜0.05）.对于中期肝癌TACE组中位生存期为14个月,1、3、5年生存率分别62.2%、13.3%、4.4%,TACE-RFA组中位生存期为32个月,1、3、5年生存率分别90.1%、52.9%、13.7%;晚期肝癌中TACE组中位生存期为12个月,1、3、5年生存率分别为35.7%、7.1%、0,TACE-RFA组中位生存期28个月,1、3、5年生存率分别为62.1%、24.1%、6.9%,在治疗中晚HCC的生存期方面两组的差异具有统计学意义（P＜0.01）.在肝功能方面,经TACE治疗485例次中60例次（12.4%）有肝功能损害需进一步行护肝对症处理,13/168例次（7.7%）RFA治疗后需相应护肝对症治疗,经方差分析差异有统计学意义（P＜0.01）.结论 TACE联合RFA治疗原发性肝癌较单独应用TACE可以更好地控制肝内病变,保护肝脏功能,延长生存期.

Objective To evaluate the clinical efficacy and survival rate of transarterial chemoembolization（TACE）alone or plus radiofrequency ablation（RFA）in patients with intermediate or advanced stage primary hepatocellular carcinoma（HCC）. Methods In this retrospective study, 467 cases received RFA or TACE plus RFA. Among them, 167 cases with strict clinical procedure（TACE alone or plus RFA）and complete follow-up data were included. Eighty-seven cases received TACE and 80 cases had TACE plus RFA between January 2000 and December 2006. Hierarchical analyses were performed using logrank tests and survival curve was estimated by Kaplan-Meier method. Results A total of 167 patients received TACE alone or plus RFA for a follow-up period of 1 to 89 months. In the TACE alone group, the time-to-progression（TTP）was an average of 3.6 months. The median survival was 13 months, one-year survival rate 52. 9%, three-year survival rate 11.5% and five-year survival rate 4. 6%. In the TACE plus RFA group, the TTP time was an average of 10. 8 months. The median survival time was 30 months, oneyear survival rate 85.0%, three-year survival rate 45.0% and five-year survival rate 11.3%. In the TACE alone group, the median survival of intermediate stage HCC was 14 months, one-year survival rate 62. 2%,three-year survival rate 13. 3% and five-year survival rate 4. 4%; In the TACE plus RFA group, the median survival of intermediate stage HCC was 14 months, one-year survival rate 90. 1%, three-year survival rate 52.9% and five-year survival rate 13. 7%. AIl differences of two groups has statistical significance（P 〈0. 05）. In intermediate stage HCC, the median survival of TACE alone group was 14 months, one-year survival rate 62. 2%, three-year survival rate 13.3%, five-year survival rate 4.4% versus 32 months,90. 1%, 52. 9% , 13.7% in the TACE plus RFA group respectively. For the advanced stage HCC, the median survival time was 12 months, one-year survival rate 35%, three-year survival rate 7. 1% and fiveyear survival rate 0 in the TACE alone group versus 28 months, 62. 1% , 24. 1% and 6. 9% in the TACE plus RFA group（P =0. 00）. There was significantly statistic difference between both groups in intermediate and advanced staging HCC. Among them, 60/485（12. 4%）patients required a therapy of post-TACE hepatic dysfunctions versus 13/168（7. 7%）in the TACE plus RFA group（P =0. 004, ANOVA method）.Conclusion The regimen of TACE plus RFA has the advantages of tumor control, liver function protection and survival extending in the treatment of HCC than TACE alone in intermediate or advanced stage HCC.