RFA、TACE及二次肝切除术治疗复发性肝癌的5年随访观察

RFA,TACE and secondary hepatectomy for recurrent hepatocellular carcinoma:a 5-year follow-up study

目的观察RFA、TACE术及二次肝切除术治疗复发性肝癌的5年随访情况。方法纳入2010年6月至2015年12月苏州高新区人民医院收治的192例复发性肝癌患者,根据患者肝癌复发后采取的治疗措施分为RFA组64例,TACE组58例,二次肝切除术组70例。比较3组患者的治疗效果,并观察并发症发生情况。术后随访5年,截止时间为2020年12月或死亡,观察患者生存情况。结果RFA组、TACE组、二次肝切除术组治疗有效率分别为95.31%(61/64)、87.93%(51/58)、98.57(69/70);TACE组治疗有效率低于二次肝切除术组(χ^(2)=6.842,P=0.033)。RFA组、TACE组、二次肝切除术组并发症总发生率分别为9.38%(6/64)、6.90%(4/58)、25.71%(18/70),二次肝切除术组并发症总发生率高于RFA组及TACE组(χ^(2)=11.107,P=0.004)。术后1、3、5年,TACE组无瘤生存率均低于RFA组及二次肝切除术组(P<0.05);术后5年,二次肝切除术组无瘤生存率低于RFA组(P<0.05)。术后1、3年,3组累计生存率比较差异无统计学意义(P>0.05);术后5年,RFA组累计生存率高于TACE组及二次肝切除术组(P<0.05)。结论TACE在治疗效果及远期生存率方面较RFA及二次肝切除术均较差,二次肝切除可能存在较高的并发症发生风险,RFA远期生存情况较好。

Objective To collect and analyze the 5-year follow-up information of patients with recurrent liver cancer treated by radiofrequency ablation(RFA),transcatheter arterial chemoembolization(TACE)and secondary hepatectomy.Methods A total of patients with recurrent liver cancer admitted to our hospital from June 2010 to December 2015 were enrolled.According to the therapeutic methods,they were divided into RFA group(64 cases),TACE group(58 cases)and secondary hepatectomy group(70 cases).The therapeutic effects of the 3 groups were compared,and the complications were observed.All patients were followed up for 5 years,and the deadline was December 2020 or death.Results The effective rates of RFA group,TACE group and secondary hepatectomy group were 95.31%,87.93%and 98.57,respectively.The effective rate of TACE group was significantly lower than that of secondary hepatectomy group(P<0.05).The incidence of complications in RFA group,TACE group and secondary hepatectomy group was 9.38%,6.90%and 25.71%,respectively.The overall incidence of complications in secondary hepatectomy group was significantly higher than those in RFA and TACE group(P<0.05).After operation of 1,3 and 5 years,the tumor free survivals rates of TACE group were significantly lower than those of RFA group and secondary hepatectomy group(P<0.05).Five years after operation,the tumor free survivals rates of secondary hepatectomy group were significantly lower than those of RFA group(P<0.05).One and 3 years after operation,there was no significant difference among the 3 groups(P>0.05).Five years after operation,the cumulative survivals rates of RFA group were significantly higher than those of TACE group and secondary hepatectomy group(P<0.05).Conclusion The treatment efficacy and long-term survival rate of patients treated by TACE are worse than those treated by RFA and secondary hepatectomy.Patients with recurrent liver cancer treated by secondary hepatectomy may have higher risk of complications,and patients treated by RFA have better long-term survival.