单纯经肝动脉化疗栓塞术及其联合微波消融治疗原发性大肝癌的疗效对比分析

Efficacy of transcatheter arterial chemoembolization alone or combined with microwave ablation in treatment of primary large liver cancer: a comparative analysis

目的回顾性分析经肝动脉化疗栓塞术（TACE）联合微波治疗与单纯TACE治疗大肝癌的近期疗效及远期生存率。方法选取2011年2月-2014年5月在北京空军总医院接受治疗的不可切除原发性大肝癌（〉5 cm）患者67例,依据治疗方法分为TACE联合微波治疗组33例及单纯TACE组34例,术后1个月复查腹部增强CT或磁共振成像（MRI）、肝功能及甲胎蛋白（AFP）,共随访3～36个月,比较近期疗效、AFP水平及远期生存率。计量资料的比较采用t检验,计数资料采用χ2检验或Fisher检验。结果联合治疗组和单纯TACE组的完全消融率分别为18/33（54.5%）和7/34（20.6%）,有效率分别为32/33（97.0%）和22/34（64.7%）,差异均具有统计学意义（P值分别为0.004、0.001）;联合治疗组患者术后AFP显著下降,与治疗前及对照组治疗后相比,差异均有统计学意义（P值均〈0.001）;两组患者均有不同程度的肝功能损伤,如转氨酶升高,未发生出血、胃瘘、结肠瘘、胆道损伤、针道转移等重度并发症及相关死亡;联合治疗组与单纯TACE治疗组的中位生存时间分别为13和9个月,平均生存时间分别为（14.00±1.63）和（10.83±1.19）个月;联合治疗组1、2、3年生存率分别为63.6%、15.2%、4.5%,单纯TACE治疗组1、2、3年生存率分别为28.4%、5.9%、0,差异具有统计学意义（P=0.044）。结论与单纯TACE治疗相比,TACE联合微波消融对于肿瘤局部控制可取得更好的疗效,显著降低患者的AFP水平,延长患者生存期,是一种安全、有效的治疗方法。

Objective To retrospectively analyze the short- term efficacy and long- term survival rates of transcatheter arterial chemoembolization（ TACE） combined with percutaneous microwave coagulation therapy（ PMCT） versus TACE monotherapy in the treatment of large primary hepatic carcinoma. Methods Sixty- seven patients with unresectable large primary hepatic carcinoma（ 5. 0 cm） who were admitted to our hospital from February 2011 to May 2014 were enrolled as subjects. Among these patients,34 patients received TACE monotherapy and 33 patients received TACE combined with PMCT. At one month after treatment,the abdomen was re- examined using contrast-enhanced computed tomography or magnetic resonance imaging,and liver function and alpha- fetoprotein（ AFP） level were measured. The follow- up period varied from 3 to 36 months. Comparison of short- term outcomes,AFP level,and long- term survival rates were performed between the two groups. Comparison of continuous data was made by t test,and comparison of categorical data by χ2test and Fisher＇s test. Results The complete ablation rate and the response rate were significantly higher in the combination therapy group than in the TACE monotherapy group（ 54. 5% vs 20. 6%,P = 0. 004; 97% vs 64. 7%,P = 0. 001）. The AFP level after treatment with combination therapy was significantly lower than that before treatment with combination therapy and that after treatment with TACE monotherapy（ P〈0. 001; P〈0. 001）. Patients in both groups had varying degrees of liver dysfunction and elevated aminotransferase,but with no severe complications such as bleeding,gastrostoma,colon fistula,bile duct injury,and needle tract metastasis,as well as deaths. The median survival time in the combination therapy group and the TACE monotherapy group was 13 months and 9 months,respectively,and the mean survival time was14. 00 ± 1. 63 months and 10. 83 ± 1. 19 months,respectively. The 1-,2-,and 3- year overall survival rates in the combination therapy group were significantly higher than those in the TACE monotherapy group（ 63. 6% vs 28. 4%; 15. 2% vs 5. 9%; 4. 5% vs 0%; P =0. 044）. Conclusion TACE combined with PMCT is a safe and effective therapy regimen,which achieves better treatment outcomes in local tumor control,substantially lower AFP level,and longer survival time than TACE monotherapy.