TACE联合射频消融治疗肝细胞癌肾上腺转移的效果及预后

TACE combined with RFA for adrenal metastasis from HCC: curative effect and prognosis

目的探究TACE联合射频消融(RFA)治疗肝细胞癌肾上腺转移的效果及预后。方法选择2002年2月至2017年3月就诊的112例肝细胞癌肾上腺转移患者作为研究对象。根据治疗方案不同将其分为TACE、RFA联合组(n=70)和TACE组(n=42)。比较两组治疗效果、不良反应及并发症发生率、预后情况。结果联合组患者60例(85.7%)肿瘤及边缘无强化,且肿瘤缩小;10例(14.3%)肿瘤大小无明显变化,但肿瘤边缘强化。TACE组患者24例(57.1%)肿瘤得到完全控制;12例(28.6%)肿瘤大小无明显变化,但肿瘤边缘强化;6例(14.3%)肿瘤明显变大,且肿瘤边缘明显强化。两组患者肿瘤控制情况比较,差异有统计学意义(P<0.05)。联合组患者不良反应及并发症发生率均高于TACE组,但差异均无统计学意义(P均>0.05)。联合组患者1、2、3年生存率分别为91.4%(64/70)、68.6%(48/70)和62.9%(44/70),均高于TACE组(P均>0.05)。联合组平均生存时间为29.23(95%CI:26.9~31.5)个月,TACE组平均生存时间为22.5(95%CI:18.9~26.0)个月,差异有统计学意义(P<0.05)。结论联合RFA治疗肝细胞癌肾上腺转移可以更好地控制肿瘤,延长患者生存时间。虽然联合RFA治疗存在更多的并发症,但经对症处理均可缓解。

Objective To investigate the curative effect and prognosis of transcatheter arterial chemoembolization(TACE) combined with radiofrequency ablation(RFA) for the treatment of adrenal metastasis from hepatocellular carcinoma(HCC).Methods A total of 112 patients with adrenal metastasis from HCC, who were admitted to authors' hospital during the period from February 2002 to March 2017,were enrolled in this study.According to the treatment scheme,the patients were divided into combination group (n =70, receiving TACE together with RFA) and TACE group(n=42,receiving TACE only).The therapeutic effect, adverse reactions,incidence of complications and prognostic results were compared between the two groups. Results In the combined group,no enhancement of the tumor and its margin was observed in 60 patients (85.7%),and the tumor volume shrank;no significant change in the tumor size was seen in 10 patients (14.3%), and the tumor margin showed enhancement.In TACE group,complete control of tumor was achieved in 24 patients (57.1%),no significant change in tumor size with tumor margin enhancement was seen in 12 patients (28.6%),and remarkable enlargement of tumor size with obvious tumor margin enhancement was observed in 6 patients(14.3%).Statistically significant difference in the degree of tumor control existed between the two groups(P<0.05).The incidence of both adverse reactions and complications in the combination group were higher than those in the TACE group,but the differences were not statistically significant(both P>0.05).The one-,2-and 3-year survival rates in the combination group were 91.4%(64/70),68.6%(48/70) and 62.9%(44/ 70) respectively,which were higher than those in the TACE group(P>0.05 in all).The mean survival time was 29.23 months(95%CI:26.9-31.5) in the combination group and 22.5 months(95%CI:18.9-26.0) in the TACE group,the difference between the two groups was statistically significant (P<0.05).Conclusion For the treatment of adrenal metastasis from HCC,TACE combined with RFA can effectively control the tumor and prolong the survival time of patients.Although TACE combined with RFA has more complications,all these complications can be alleviated by symptomatic treatment.