射频消融联合肝动脉化疗栓塞治疗原发性肝癌的临床疗效

Clinical outcomes of radiofrequency ablation combined with transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma： a single-center experience

目的探讨经皮射频消融（RFA）联合经皮肝动脉插管化疗栓塞（TACE）治疗原发性肝癌的临床疗效。方法将确诊的62例原发性肝癌患者（肿瘤最大直径3—5cm）随机分为RFA联合TACE组（联合组）和单纯RFA组（射频组）。其中联合组患者先行TACE治疗，1周后再行RFA治疗；射频组患者直接行RFA治疗。随访时间9～39个月，采用Kaplan-Meier方法进行生存分析，Logrank检验比较生存曲线差异。结果联合组患者的1、2、3年总生存率分别为90．6％、72．0％和53．1％，单纯射频组患者的1、2、3年总生存率分别为86．6％、63．3％和40．0％，差异无统计学意义（P=0．176）。联合组患者的1、2、3年无瘤生存率分别为75．0％、50．0％和34．3％，单纯射频组患者的1、2、3年无瘤生存率分别为63．3％、33．3％、16．7％，差异有统计学意义（P=0．027）。联合组患者的1、2、3年局部肿瘤进展率分别为12．5％、18．8％和18．8％，单纯射频组患者的1、2、3年局部肿瘤进展率分别为16．7％、30．0％和36．6％，差异有统计学意义（P=0．047）。结论对于最大直径为3—5cm的原发性肝癌患者，RFA联合TACE的疗效优于单纯RFA。

Objective To compare the effect of radiofrequency ablation （RFA） combined with transcatheter arterial chemoembolization （TACE） with radiofrequency ablation alone for the treatment of 3-5 cm hepatocellular carcinoma （HCC）. Methods From January 2006 to March 2010, sixty-two HCC patients were randomly treated with RFA combined with TACE （ n = 32 ） or RFA alone （ n = 30 ） . This group included the patients who had Child-Pugh class A or B with three or fewer tumors, in which just one tumor size was 3-5 cm in diameter, and no evidence of extrahepatic tumor metastasis or macrovascular invasion. The follow up ranged from 9 to 39 months. Survival probabilities were estimated with the Kaplan- Meier method, and differences between survival curves were evaluated with the Log rank test. Results At the end of the study, the 1-, 2- and 3-year overall survival rates in the combined treatment group were 90.6%, 72%, and 53.1%, respectively, and in the radiofrequency ablation alone group were 83.3%, 56.75%, and 23.3%, respectively. The differences between the survival curves of the two groups were not statistically significant （P = 0. 176）. The 1-, 2-, and 3-year progress-free survival rates in the combined treatment group were 75.0%, 50.0%, and 34.3%, respectively, and in the radiofrequency ablation alone group were 63.3%, 33.3%, and 16. 7%, respectively. The differences between the two groups were statistically significant （P = 0. 027）. The 1-, 2-, and 3-year local tumor progression rates in the combined treatment group were 12.5%, 18.75%, and 18.75% vs. 16.7%, 30%, and 36. 6% in the radiofrequeney ablation alone group, with a significant difference between the two groups （P = 0. 047 ）. Conclusion Radiofrequency ablation plus TACE is better than radiofrequency ablation alone for the treatment of 3-5 cm hepatocellular carcinoma.