射频消融联合放射性125I粒子植入治疗多结节型原发性肝癌疗效分析

Efflcocy nnalysis of radiofrequency ablation combined with 125I seed for multiple nodular hepatocellular carcinoma

目的分析射频消融（RFA）联合放射性125I粒子植入治疗多结节型原发性肝癌（HCC）的临床疗效及患者生存状况。方法回顾性分析丽水市中心医院2009年1月至2014年9月47例临床诊断或病理确诊的多结节型HCC患者完整临床及随访资料。根据治疗方式分为RFA组29例，RFA联合粒子治疗组18例。采用Kaplan-Meier方法进行生存分析，Log-rank比较生存曲线差异。结果两组患者一般临床资料及肿瘤情况比较差异无统计学意义。随访时间2～55个月，中位随访时间22个月。RFA联合粒子治疗组与RFA组的中位肿瘤无进展生存期（PFS）分别为18和11个月，差异有统计学意义（P=0．036）；两组1、2、3年总生存率（0s）分别为94．4％、78．0％、66．8％和88．5％、68．6％和57．1％，差异无统计学意义（P=0．554）。结论对于多结节型HCC，RFA联合放射性125I粒子治疗能延长肿瘤无进展生存时间，在肿瘤局部控制率方面具有优势，短期疗效优于RFA，长期疗效有待大样本对照研究证实。

Objective To investigate the clinical efficacy of radiofrequency ablation（RFA）combined with 125eed in patients with multiple nodular hepatocellular carcinoma （HCC）. Methods The clinical data of 47 patients with multiple nodular HCC confirmed clinically or pathologically in the Fifth Affiliated Hospital of Wenzhou Medical University between January 2009 and September 2014 were retrospectively analyzed. All patients were divided into two groups depending on treatment： RFA group （ n = 29 ） ; RFA combined with 125I seed group（n = 18）. Survival time was estimated with the Kapln-Meier analysis. The survival curve was compared by Log-rank test. Results The clinical data and tumor situation of patients between two groups did not show significant differences. The follow-up time ranged from 2 to 55 months. At the end of the study, the median progression-free survival of two groups were 18 months and 11 months, and the differences were statistically significant（ P = 0. 036）. The overall survival rates in RFA combined with 125I seed group at 1, 2, and 3 years （94. 4%, 78.0%, 66. 8%, respectively） were higher than those in RFA group （88.5% , 68.6% , 57. 1% , respectively）. However, the differences between the two groups were not statistically significant（ P = 0. 554 ）. Conclusions For multiple nodular HCC, RFA combined with 125I seed can prolong progression-free survival, have an advantage in local control rate, and is better than single RFA at short-term curative effect. However, its long-term outcomes should be further explored by a large- sample, multi-center and randomized trial.