射频消融联合免疫疗法治疗肝癌的中远期疗效分析

Middle and long term efficacy of radiofrequency ablation combined with immunotherapy in the treatment ofhepatocellular carcinoma

目的：探讨经皮射频消融联合免疫治疗对肝癌的疗效及其安全性。方法将124例肝癌患者按照随机数字表法分为两组，对照组60例，观察组64例，对照组给予单纯免疫治疗，观察组给予经皮射频消融联合免疫治疗，观察两组中远期疗效。结果两组治疗后肿瘤直径、血清AFP和癌胚抗原（ CEA ）水平均显著下降（t＝4．867，P＝0．005；t＝5．175，P＝0．004；t＝3．155，P＝0．025；t＝4．845，P＝0．005；t＝4．031，P＝0.010；t＝2．668，P＝0．044），但观察组下降程度优于对照组（t＝4．119，P＝0．009；t＝3．621，P＝0．015；t＝3.492，P＝0．017）。观察组总有效率和疾病控制率分别为53．1％、78．1％，显著高于对照组的28．3％，46．7％（χ2＝11.290，P＝0．010；χ2＝21．290，P ＝0．000）。观察组治疗后第1年、第3年、第5年生存率分别为60.9％、31.3％、12．5％，对照组分别为21．7％、5．0％、0．0％，观察组中远期生存率显著高于对照组（χ2＝21.935，P＝0.000；χ2＝56．452，P＝0．000；χ2＝40．516，P＝0．000）。两组治疗前CD4＋、CD8＋、CD4＋/CD8＋、IL-12等指标差异无统计学意义，但治疗后观察组以上指标均得到显著改善（ t＝4．515，P＝0．006；t＝10．014，P＝0.000；t＝5.217，P＝0．003）。结论经皮射频消融联合免疫治疗治疗肝癌的中远期疗效显著，不良反应少，安全性好，能显著提高患者生活质量和生存率，具有较好的临床应用价值。

Objective To evaluate the efficacy and safety of percutaneous radiofrequency ablation combined with immunotherapy in the treatment of hepatocellular carcinoma .Methods A total of 124 patients with liver cancer were randomly divided into the two groups .60 cases in the control group were given immunity treatment alone ,while 64 cases in the observation group were treated by percutaneous radiofrequency ablation combined with immune therapy . The middle and long term curative effect of two groups was observed .Results After treatment,the tumor diameter, serum alpha fetoprotein （AFP） and carcino-embryonic antigen （CEA） levels in the two groups were significantly decreased（t=4.867,P=0.005;t=5.175,P=0.004;t=3.155,P=0.025;t=4.845,P=0.005;t=4.031,P=0.010;t=2.668,P=0.044）,but the declining degree of the observation group was better than the control group （t=4.119,P=0.009;t=3.621,P=0.015;t=3.492,P=0.017）.The total effective rates and disease control rates of the observation group were 53.1%,78.1%,which were significantly higher than 28.3%,46.7%in the control group （χ2 =11.290,P=0.010;χ2 =21.290,P=0.000）.The 1-year,3-year,5-year survival rates of the observation group were 60.9%,31.3%,12.5%,those of the control group were 21.7%,5.0%,0.0%,the middle and long term sur-vival rates of the observation group were significantly higher than the control group （χ2 =21.935,P=0.000;χ2 =56.452,P=0.000;χ2 =40.516,P=0.000）.No statistically significant differences in the CD 4＋,CD8＋,CD4＋/CD8＋, IL-12 and other indicators between the two groups before treatment ,but these indicators in the observation group were significantly improved after treatment （t =4.515,P =0.006;t =10.014,P =0.000;t =5.217,P =0.003）. Conclusion Combination of percutaneous radiofrequency ablation and immunotherapy in the treatment of hepatocell-lular carcinoma has exact effect and with advantages of less adverse reaction , good safety , which can significantly improve the quality of life and survival rate of patients ,it has good clinical application value .