聚焦超声消融联合TACE治疗10 cm以上大肝癌的临床效果分析

Clinical analysis of focused ultrasound ablation combined with TACE in the treatment of larger than 10 cm hepatocellular carcinoma

目的 初步评价聚焦超声消融（Focused Ultrasound Ablation，FUA）联合肝动脉化疗栓塞（Transcatheter arterial chemoembolization，TACE）治疗最大径10 cm以上大肝癌的临床效及安全性。方法 回顾性分析近5年在我院接受FUA联合TACE治疗的原发性肝癌患者19例（34个病灶），肿瘤最大径10 cm以上，BCLC分期为B期8例，C期11例。术后通过增强MRI评价局部病灶消融效果，定期复查评价血清甲胎蛋白AFP）下降效果，应用SIR标准评价治疗并发症，随访统计总生存率、中位生存时间、肿瘤进展时间及局部复发时间。 结果 （1）所有34个病灶治疗后均达到完全消融（CR）或部分消融（PR），CR10.5%），PR 1789.5%）；（2）17例血清AFP升高病例中，治疗后1月AFP均不同程度降低，降至正常2例，11例下降超过50%，4例下降低于50%；（3） 患者总生存时间（OS）8.0～69个月，中位OS 16个月；局部复发时间（TTR）3～34个月，中位TTR 6个月；肿瘤进展时间（TTP）2～34个月，中位TTP 5个月。1年、2年、3年的累积生存率分别为：63.2%、26.3%和15.8%；（4）主要并发症包括：发热、皮肤损伤、术后局部疼痛、肝功能损伤、肋骨病理性骨折等，84.4%（38/45）为轻度，未出现治疗相关性死亡等严重并发症。结论 FUA联合TACE治疗最大直径10 cm以上原发性肝癌，能患者够获得较好的生存获益，安全性可控，值得深入探讨。

Objective： Preliminary evaluation of clinical efficacy and safety of FUA combined with TACE in the treatment of large hepatocellular carcinoma with maximum diameter above 10cm. Methods： Retrospective analysis of 19 cases of HCC treated by FUA ablation combined with TACE in our hospital during the past 5 years, altogether 34 lesions, with maximum tumor diameter above 10cm Among these 19 patients, BCLC stage B was seen in 8 cases, C in 11 cases. The effect of local lesion ablation was evaluated by enhanced MRI after operation, by application of SIR standard the complications, total survival rate, median survival time, tumor progression time and local recurrence time were followed up. Results： （1） All 34 lesions were treated with complete ablation （CR） or partial ablation （PR）, CR：10.5% （1/19）, PR：89.5% （17/19）. （2） In 17 patients with elevated serum AFP, their AFP values were all decreased to certain degree one month after the procedure, including, AFP dropped to normal in 2 cases, to over 50% in 11 and dropped below 50% in 4 cases. （3） OS was 8 to 69 months, median OS was 16 months, TTR was 3 to 34 months, median TTR was 6 months, TTP was 2 to 34 months, and median TTP was 5 months. The cumulative survival rates of 1 year, 2 years, and 3 years were 63.2%, 26.3% and 15.8%. （4） Major complications of FUA included： fever, skin injury, pain in the operated site, liver function damage, pathological fracture of ribs, 84.4% （38/45） mild., No treatment related death or other serious complications. Conclusions： Preliminary studies show that FUA ablation combined with TACE to treat maximum diameter of above 10cm HCC, is a promising and safe way to obtain better survival benefit, , thus, it’s worthy of further exploration.