肝动脉化疗栓塞联合射频消融治疗直径≥5cm肝细胞癌患者10年疗效及预后分析

Long term outcome of combining transarterial chemoembolization and radiofrequency ablation therapy for large hepatocellular carcinoma

目的探讨经导管肝动脉化疗栓塞(TACE)联合射频消融(RFA)治疗直径≥5 cm肝细胞癌(HCC)患者的远期疗效及预后影响因素。方法选择2006年1月至2015年12月天津第三中心医院收治并接受RFA治疗或RFA联合TACE治疗的HCC患者79例。其中36例HCC患者行单纯RFA治疗(RFA组),43例HCC患者行TACE联合RFA治疗(TACE联合组)。TACE联合组患者在TACE术后2周内进行RFA治疗。采用χ~2检验比较TACE联合组与RFA组患者肿瘤首次完全消融率差异;采用Kaplan-Meier法对2组患者进行生存分析,并采用Log-rank检验比较2组患者的生存率。采用Cox回归分析直径≥5 cm的HCC患者预后的影响因素。结果 TACE联合组患者肿瘤首次完全消融率93.0%(40/43),RFA组患者肿瘤首次完全消融率为91.7%(33/36),两者比较差异无统计学意义(χ~2=0.051,P=0.821)。TACE联合组及RFA组患者1、3、5、7、10年肿瘤无进展生存率分别为78.8%、56.1%、38.4%、25.2%、16.8%及69.0%、40.0%、20.1%、13.4%、13.4%,两者差异无统计学意义(χ~2=3.561,P=0.059);TACE组患者1、3、5、7、10年总生存率分别为83.4%、 57.6%、 45.9%、 41.3%、31.0%,高于RFA组患者的68.8%、40.2%、24.1%、16.2%、16.2%,且差异有统计学意义(χ~2=4.681,P=0.030)。单因素分析结果显示,合并门脉分支瘤栓、肿瘤无假包膜以及甲胎蛋白(AFP)浓度升高是影响直径≥5 cm的HCC患者总生存时间的因素;进一步多因素分析结果显示,合并门脉分支瘤栓及AFP浓度升高是影响直径≥5 cm的HCC患者总生存时间的独立危险因素。结论 TACE联合RFA治疗能延长直径≥5 cm HCC患者的生存时间,改善患者预后;合并门脉分支瘤栓及AFP浓度是影响直径≥5 cm HCC患者预后的独立危险因素。

ObjectiveTo investigate the long-term prognosis of patients with large hepatocellular carcinoma （HCC） receiving radiofrequency ablation （RFA） after transarterial chemoembolization （TACE） with patients treated by RFA alone and clarify the prognostic factors. MethodsA total of 79 patients with a tumor more than 5 cm receiving combined treatment of RFA and TACE （43 patients） or RFA alone （36 patients） between January 2006 and December 2015 were enrolled in this study. Patients in the combined treatment group received RFA within two weeks after TACE. The complete ablation rates of two groups were compared using χ^2 test. Survival analysis was conducted using Kaplan Meier methods. Log-rank examination was performed to compare the survival rate of the two groups. The prognostic factors were determined by Cox regression model. ResultsComplete response rates of the combined treatment group and the RFA alone group were 93% and 91.7%, respectively （χ^2=0.051, P=0.821）. The 1-, 3-, 5-, 7- and 10-year tumor progress-free survivals were 78.8%, 56.1%, 38.4%, 25.2% and 16.8% for the combined treatment group and 69.0%,40%, 20.1%, 13.4% and 13.4% for the RFA alone group （χ^2=3.561, P=0.059）. The 1-, 3-, 5-, 7- and 10-year overall survivals in the combined treatment group were better than those in the RFA alone group （83.4%, 57.6%, 45.9%, 41.3%, 31.0% vs 68.8%, 40.2%, 24.1%, 16.2%, 16.2%, χ2=4.681, P=0.030）. The univariate Cox proportional hazards regression model revealed a high level of AFP tumor embolus in portal vein and the tumor without a capsule were related to short overall survival. However, the multivariate analysis showed that only the ？rst two factors were independent risk factors for overall survival. ConclusionPatients with a large HCC receiving RFA after TACE can get a better long-term prognosis compared with those receiving RFA alone. Patients with a high level of AFP and tumor embolus in portal vein were at the risk of poor prognosis.