微波消融与动脉介入联合微波消融治疗原发性肝癌的对比研究

Effect observation between MTC and MTC combining with TACE for the treatment of hepatocellular carcinoma

目的:比较原发性肝癌局部治疗中单纯微波消融(MTC)与动脉介入后联合微波消融治疗(TACE+MTC)的疗效。方法:选取48例原发性肝癌患者作为研究对象(共88个肿瘤灶),按肿瘤最大径分为小瘤组(≤5cm)和大瘤组(>5cm)。每组44个瘤灶。不完全随机行单纯MTC治疗(22个肿瘤灶)和MTC+TACE治疗(22个肿瘤灶;5-氟尿嘧啶1.0g,多柔比星60mg,顺铂80mg,羟基喜树碱20mg)。治疗结束后对肿瘤进展情况进行观察。结果:小瘤组,TACE+MTC治疗组和单纯MTC治疗组比较,有效率分别为54.5%(12/22)和50.0%(11/22),P=0.763;1年生存率分别为83.3%(10/12)和81.2%(9/11),P=1.000。大瘤组,TACE+MTC治疗组和单纯MTC治疗组比较,有效率分别为40.9%(9/22)和18.2%(4/22),P=0.023;1年生存率分别为69.2%(9/13)和25.0%(3/12),P=0.047。结论:直径≤5cm的肝肿瘤可以采用单纯MTC治疗;而>5cm的肿瘤,TACE+MTC治疗能取得更好的疗效。

OBJECTIVE： To evaluate the clinical effect between microwave tissue coagulation （MTC） and MTC combining with transcatheter arterial chemoembolization （TACE） for the treatment of hepatocellular carcinoma. METHODS： A total of 88 tumors from 48 cases of hepatocellular carcinoma patients were recruited. The tumors were divided into two subgroups： smaller tumor （45 cm） group and larger tumor （〉5 cm） group according to the maximum of tumor diameter. In each group,22 tumors were treated with either MTC alone or MTC combining with TACE （5-fluorouracil 1.0 g, adramycin 60 mg, cisplatin 80 mg, hydroxycamptothecin 20 mg）. Time to progression of tumors was observed after treatment. RESULTS： Treatment effect was similar in the smaller tumor group between MTC alone and MTC combining with TACE, which were 50.0% （11/22） and 54. 5 % （12/22） respectively,and no significant difference was observed （P=0. 763）; The 1-year survival rates were 81.2%（9/11） and 83.3 % （10/12） respectively （P= 1. 000）. While in the larger tumor group, MTC combining with TACE obviously prolonged the time of tumor progression than MTC alone, the effect rates were 40.9 % （9/22） and 18.2 % （4/22） respectively, and the difference was significant （P = 0.023） ; The 1-year survival rates were 69.2 （9/13） and 25.0 % （3/12 ）, and the difference was significant （P=0. 047）. CONCLUSION：For tumors with diameter less than 5 cm, MTC alone was feasible, whereas for tumors with diameter more than 5 cm, MTC combining： with TACE might be more suitable for hepatocellular carcinoma.