TACE联合微波消融术治疗中晚期肝细胞肝癌的疗效

Efficacy of TACE combined with MWA in the treatment of advanced hepatocellular carcinoma

目的:探讨肝动脉灌注化疗栓塞术(TACE)联合微波消融术(MWA)治疗中晚期肝细胞肝癌(HCC)的疗效。方法:选取介入治疗的95例原发性HCC患者为研究对象,依据治疗方式不同分为TACE组(n=54)和联合组(n=41)。TACE组行单侧TACE治疗;联合组行TACE联合MWA治疗。比较两组患者客观缓解率(ORR)、疾病控制率(DCR)、无进展生存期(PFS)、总生存期(OS);观察患者治疗前后血清癌胚抗原(CEA)、糖链抗原199(CA199)、肿瘤相关黏液抗原(CA242)及血管内皮生长因子(VEGF)、血小板衍生生长因子(PDGF)、碱性成纤维细胞生长因子(bFGF)水平;比较两组患者不良反应发生情况。结果:联合组ORR高于TACE组(P<0.05),而两组患者DCR比较,差异无统计学意义(P>0.05);联合组中位PFS及OS长于TACE组(P<0.05)。治疗后,联合组血清CEA、CA199、CA242及VEGF、PDGF、bFGF水平低于TACE组(P<0.05)。两组患者术后不良反应发生率比较,差异无统计学意义(P>0.05)。结论:TACE联合MWA治疗中晚期HCC能够有效降低血清肿瘤标志物及血管生成因子水平,提高疾病缓解率,并延长PFS与OS,且安全性良好。

Objective:To investigate the efficacy of transcatheter arterial chemoembolization(TACE)combined with microwave ablation(MWA)in the treatment of advanced hepatocellular carcinoma(HCC).Methods:The clinical data of 95 patients with primary HCC were collected,and divided into TACE group(n=54)and combined group(n=41)according to the different treatment methods.TACE group was treated with unilateral TACE,and combination group was treated with TACE combined with MWA.The objective response rate(ORR),disease control rate(DCR),progression-free survival(PFS)and overall survival(OS)were compared between the two groups,and the levels of serum carcinoembryonic antigen(CEA),carbohydrate antigen 199(CA199),tumor associated mucus antigen(CA242),vascular endothelial growth factor(VEGF),platelet-derived growth factor(PDGF)and basic fibroblast growth factor(bFGF)were observed before and after treatment,and the adverse reactions were recorded.Results:The ORR rate of the combined group was higher than that of the TACE group(P<0.05),and there was no statistical difference in DCR between the two groups(P>0.05).The median PFS and OS in the combined group were longer than them of the TACE group(P<0.05).After treatment,the levels of serum CEA,CA199,CA242,VEGF,PDGF and bFGF in the combined group were significantly lower than those in TACE group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:TACE combined with MWA in the treatment of advanced HCC,can effectively reduce the level of tumor markers and angiogenic factors in serum,improve the remission rate of disease,and prolong PFS and OS,with good safety.