肝动脉化疗栓塞术联合射频消融术治疗中期原发性肝癌患者的疗效

Effects of transcatheter arterial chemoembolization combined with percutaneous radiofrequency ablation on patients with intermediate stage primary liver cancer

目的探讨肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)联合射频消融术(radiofrequency ablation,RFA)治疗中期原发性肝癌患者的近期疗效及安全性。方法选取2008年6月至2016年10月首都医科大学附属北京地坛医院收治的接受TACE联合RFA治疗的96例中期原发性肝癌患者为研究对象,回顾性分析患者术后1年内不同时间点甲胎蛋白变化及肝内局部病灶控制情况,采用m RECIST标准进行疗效评估,分析临床基线特征对疗效的影响,记录术后不良反应及随访生存情况。结果患者的中位随访时间为30个月(6~76个月),中位生存时间为34个月,在随访过程中联合治疗的客观缓解率为56.25%(54/96),疾病稳定及疾病进展率分别为36.5%(35/96)和7.3%(7/96)。联合治疗对初始肿瘤具有假包膜的患者疗效更佳。在67例甲胎蛋白阳性患者中,甲胎蛋白水平在治疗后1个月、3个月及6个月下降者分别占91.04%、91.04%及80.6%,不良反应多为术后短时间内发热、局部疼痛及肝功能一过性异常,总体安全性高,患者可耐受。结论采取TACE联合RFA治疗中期原发性肝癌患者安全、有效,联合治疗的近期疗效影响患者总体生存。

Objective To evaluate the short-term effects and safety of transcatheter arterial chemoembolization(TACE)combined with radiofrequency ablation(RFA)on patients with intermediate stage primary liver cancer(PLC).Methods Total of 96 patients with intermediate stage PLC in Beijing Ditan Hospital,Capital Medical University from June 2008 to October 2016 were selected.The serum alpha-fetoprotein(AFP)level and therapeutic efficacy of focal lesions were evaluated at different time points in one year after treatment.The therapeutic effects were evaluated by mRECIST.The relationships of the clinical baseline characteristics with curative effect were assessed.The complications and follow-up survival conditions were also observed.Results The median followed-up period was 30 months(6~76 months)and the median survival period was 34 months.The objective response rate was 56.25%(54/96),the stable disease rate was 36.5%(35/96),and the progressive disease rate was 7.3%(7/96).The effects of combination therapy on patients with initial tumor with pseudo-capsule was better.In 67 patients with AFP-positive,the level of serum AFP decreased by 91.04%,91.04%and 80.6%at 1 month,3 months and 6 months after treatment,respectively.The major postoperative adverse effects were fever,pain and mild-to-moderate abnormal liver function.The overall security was high and the patients could tolerate.Conclusions TACE combined with RFA is safe,feasible and effective in the treatment of patients with intermediate stage primary liver cancer.The short-term curative effect is an important factor to determine the survival rate of the patients.