肝动脉栓塞化疗术联合射频消融治疗初发性及复发性肝癌的疗效及影响因素分析

Analysis of the efficacy of transcatheter arterial chemoembolization combined with radiofrequency ablation for treatment of primary hepatocellular carcinoma and recurrence hepatocellular carcinoma and the risk factors of prognosis

目的本研究分析应用肝动脉栓塞化疗术(TACE)联合射频消融(RFA)治疗原发性及复发性肝癌的治疗效果及影响预后的因素。方法选择2015年2月至2017年2月在我院进行TACE联合RFA治疗的70例肝癌病人,根据肝癌情况分为初发组和复发组,采用log-rank检验比较2组病人生存率是否有统计学差异。根据病人预后生存情况分为预后良好组和预后不良组,利用Cox回归模型对所有可能影响预后的因素进行分析。结果初发组及复发组均取得较好疗效,2组差异无统计学意义(P>0.05)。总胆红素(P=0.009)、Child-Pugh分级(P=0.003)、甲胎蛋白(AFP)(P=0.006)、合并肝静脉侧支循环(P=0.012)是影响病人预后的独立危险因素。结论 TACE联合RFA治疗原发或复发性肝癌疗效安全肯定,总胆红素、Child-Pugh分级、AFP和合并肝静脉侧支循环是影响病人预后的独立危险因素。

Objective To study the efficacy of transcatheter arterial chemoembolization（TACE）combined with radiofrequency ablation（ RFA） for primary and recurrent hepatocellular carcinoma and to analyze the risk factors of prognosis. Methods The clinical data of 70 patients with hepatocellular carcinoma treated with TACE combined with RFA during February 2015 to February 2017 in our hospital were enrolled in the study. According to the condition of hepatocellular carcinoma,they were divided into the initial group and the relapse group. The log-rank test was used to compare the survival rates of the two groups. According to the prognosis,patients were divided into the better prognosis group and poorer prognosis group. Cox regression model was used to find out the possible factors that influenced the prognosis. Results The initial group and the relapse group both had good efficacy,and the difference was not statistically significant（ P〉0. 05）. The total bilirubin（ P = 0. 009）,child-pugh grading（ P =0. 003）,AFP（ P = 0. 006）,and the combined hepatic venous lateral branch circulation（ P = 0. 012）were independent risk factors affecting the prognosis of patients. Conclusions TACE combined with RFA is safe and efficient for the initial or relapse hepatocellular carcinoma. The independent risk factors for the prognosis of patients are total bilirubin,child-pugh grading,AFP and the combined hepatic venous collateral circulation.