经肝动脉化疗栓塞联合微波消融治疗BCLC早期肝癌的效果及无进展生存期的影响预后因素分析

Transcatheter arterial chemoembolization combined with microwave ablation for treatment of early liver cancer: Efficacy and prognostic factors for progression-free survival

背景经肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)和微波消融术(microwave ablation,MWA)是国内外肝癌治疗的主要手段,TACE术可阻断肝癌供血血管,并可清晰显示肿瘤所在区域,序贯应用MWA可以将实体瘤完全消融.但无论哪种术式,肝癌术后复发问题都难以解决,目的分析经肝动脉化疗栓塞联合微波消融治疗巴萨罗那临床肝癌分期(barcelona clinic liver cancer,BCLC)早期肝癌的效果及影响复发的因素.方法回顾性分析了2016-02/2017-11在昆明市第三人民医院行TACE联合MWA治疗的乙肝病毒(hepatitis B virus,HBV)感染后的BCLC早期肝癌患者42例,术后即刻评价疗效,记录并发症,所有患者完成WMA后1 mo、2mo、3 mo、6 mo、12 mo、18 mo复查增强CT、甲胎蛋白(alpha-fetoprotein,AFP)、肝功和或肝动脉造影,记录复发时间.结果截至随访时,手术总有效率为61.5%,病灶控制率为84.2%.中位无进展生存期(progression-free-survival,PFS)为7.3 mo(范围2.3-34 mo).单因素分析中,女性患者的PFS为14 mo,男性的PFS为11 mo.≥60岁的患者PFS为3.8 mo,<60岁患者的PFS为8.9 mo.<3 cm的肿瘤PFS为14 mo,3-5 cm为10.7 mo,5-10 cm以上的肿瘤PFS为11.2 mo.单个肿瘤的PFS为13.6 mo,≥2个肿瘤的PFS为4 mo.Child A级的PFS为20.8 mo,Child B级的PFS为11.2 mo,Child A级患者的PFS高于Child B级的患者.BCLC 0期的患者PFS为15.5 mo,BCLC A期的患者PFS为11.2 mo,BCLC 0期患者的PFS明显高于BCLC A期.术前HBV-DNA阳性的患者PFS为11.2 mo,HBV-DNA阴性的患者PFS为13.3 mo.HBeAg阳性的中位PFS为11.2 mo,HBeAg阴性的PFS为13.3 mo.单因素分析显示,性别、年龄、Child分级、肿瘤数目、BCLC分期有统计学差异,肿瘤大小、术前HBVDNA、HBeAg阳性无统计学差异.在多因素分析中,Child分级、BCLC A期、性别为影响TACE序贯MWA的HBV感染后的的BCLC早期肝癌的PFS的独立危险因素(P<0.05).结论TACE序贯MWA治疗BCLC早期肝癌是安全有效的,Child分级、BCLC分期、性别可能影响术后复发.

BACKGROUND Transcatheter arterial chemoembolization(TACE)and microwave ablation(MWA)are the main methods for the treatment of liver cancer worldwide.TACE can block the blood vessels of liver cancer and clearly show the area where the tumor is located.The solid tumor can be completely ablated by MWA.However,postoperative recurrence is still a difficult problem to solve.AIM To assess the efficacy of TACE combined with MWA in the treatment of liver cancer at early Barcelona clinic liver cancer(BCLC)stage and identify the factors affecting recurrence.METHODS A retrospective analysis was performed on 42 patients with post-hepatitis B virus(HBV)liver cancer at early BCLC stage who underwent TACE combined with MWA at our hospital from February 2016 to November 2017.After surgery,the efficacy was evaluated and complications were recorded.The patients were followed at 1 mo,2 mo,3,mo 6 mo,12 mo,and 18 mo after WMA for CT,alpha fetoprotein(AFP),liver function,or hepatic angiography,and the time to recurrence was recorded.RESULTS By the last follow-up,the total effective rate was 61.5%and the lesion control rate was 84.2%.The median progression-free-survival(PFS)was 7.3 mo(range,2.3-34).Univariate analysis showed that female patients had a PFS of 14 mo and male patients had a PFS of 11 mo.Patients≥60 years of age had a PFS of 3.8 mo,and patients<60 years of age had a PFS of 8.9 mo.The PFS of patients with tumor<3 cm,3 to 5 cm,and 5-10 cm was 14,10.5,and 11.2 mo,respectively.The PFS of patients with single tumor and multiple tumors was 13.6 and 4 mo,respectively.The PFS of patients with Child A and Child B disease was 20.8 mo vs 11.2 mo.The PFS of BCLC stage 0 patients and BCLC stage A patients was 15.5 mo vs 11.2 mo.HBV-DNA positive patients had a PFS of 11.2 mo,and HBV-DNA negative patients had a PFS of 13.3 mo.The median PFS of HBeAg-positive cases was 11.2 mo,and that of HBeAg-negative cases was 13.3 mo.Univariate analysis showed that gender,age,Child grade,number of tumors,and BCLC stage were significantly correlated with PFS,but tumor size,preoperative HBV-DNA,and HBeAg status did not.In multivariate analysis,Child grade,BCLC stage,and gender were identified to be independent risk factors for PFS in early BCLC stage liver cancer patients undergoing sequential treatment of TACE and MWA(P<0.05).CONCLUSION TACE combined with MWA is safe and effective in the treatment of early BCLC stage liver cancer.Child grade,BCLC stage,and gender may affect postoperative recurrence.