经导管肝动脉化疗栓塞术联合微波消融用于复发性肝癌的预后及其相关预测因素分析

Prognosis of recurrent hepatocellular carcinoma patients after TACE combined with microwave ablation and analysis of prognosis-related predictive factors

目的探讨经导管肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)联合微波消融(microwave ablation,MWA)治疗复发性肝癌患者的预后及其相关因素,构建总生存率预测列线图。方法回顾性纳入2015年1月—2017年1月于浙江金华广福医院行TACE-MWA治疗的82例复发性肝癌患者的临床资料,根据预后分为进展组、无进展组、存活组、死亡组。记录患者病情进展和生存情况,分析二者的影响因素,建立列线图预测模型。结果患者治疗后2年总生存率为68.29%,无进展生存率为36.59%;进展组术前血清甲胎蛋白(AFP)水平高于无进展组,肿瘤数目和最大肿瘤直径均大于无进展组(均P<0.05);死亡组最大肿瘤直径大于存活组,肿瘤近肝门<2 cm例数和术前AFP水平均高于存活组,2组Child-Pugh、BCLC分级例数分布差异有统计学意义(均P<0.05);术前AFP水平、肿瘤数目、最大肿瘤直径(HR=1.026、51.487、2.463,P=0.024、0.047、0.016)为患者无进展生存危险因素;术前AFP水平、最大肿瘤直径、肿瘤近肝门<2 cm(HR=1.012、1.189、8.479,P=0.002、0.011、0.021)为患者总生存率危险因素;总生存率列线图一致性指数为0.919(95%CI:0.885~0.946)。结论肿瘤数目、大小、位置等因素对TACE-MWA治疗后复发性肝癌患者无进展生存和总体生存具有一定预测意义。

Objective To explore the prognosis of recurrent hepatocellular carcinoma patients after transcatheter arterial chemoembolisation(TACE) combined with microwave ablation(MWA) and its related factors, constructing a prognostic nomogram concerning overall survival. Methods Retrospective analysis was performed on clinical data from recurrent hepatocellular carcinoma patients(82 cases) treated by TACE-MWA in our hospital from January 2015 to January 2017. The patients were divided into progress, non-progress, survival, and death groups depending on disease progression and survival. The progression and survival situation during 2 years of follow-up were recorded, and the related factors for both were analysed. A prognostic nomogram was then constructed. Results The overall survival of patients in the two years after TACE-MWA was 68.29%, and the progression-free survival rate was 36.59%. The preoperative AFP level, tumour number, and largest tumour diameter in the progress group were higher than those in the non-progress group(all P<0.05). The largest tumour diameter, cases with tumour close to hepatic hilum<2 cm, and preoperative AFP level in the death group were higher than those in the survival group(all P<0.05). Statistical differences were observed between the two groups in terms of Child-Pugh classification and BCLC classification(all P<0.05). The preoperative AFP level, tumour number, and largest tumour diameter(HR=1.026, 51.487, 2.463;P=0.024, 0.047, 0.016, respectively) were the risk factors of recurrent hepatocellular carcinoma patients’ progression-free survival. Preoperative AFP level, largest tumour diameter, and tumour proximity to hepatic hilum<2 cm(HR=1.012, 1.189, 8.479;P=0.002, 0.011, 0.021, respectively) were the risk factors of recurrent hepatocellular carcinoma patients’ overall survival. The consistency index for predicting patients’ overall survival in two years was 0.919(95% CI: 0.885-0.946). Conclusion Emphasising on factors such as tumour number, size, and location has certain meaning for predicting the progression-free survival and overall survival of hepatocellular carcinoma patients after TACE-MWA.