经肝动脉化疗栓塞联合局部消融治疗外科术后复发性肝癌的预后分析

A prognostic analysis of transcatheter arterial chemoembolization combined with local ablation in treatment of recurrent liver cancer after surgery

目的探讨外科术后复发性肝癌经肝动脉化疗栓塞(TACE)联合局部消融治疗的临床疗效及影响预后的危险因素。方法回顾性分析2017年1月—2020年12月于宁夏医科大学总医院接受TACE联合局部消融治疗的47例外科术后复发性肝癌患者的资料。局部消融治疗后开始随访,评价近期疗效并随访其生存情况。对可能影响预后的因素作单因素及多因素分析,单因素分析运用Kaplan-Meier模型及log-rank检验分析,多因素分析采用Cox比例风险回归模型。结果47例外科术后复发性肝癌患者治疗后3个月,总体有效率(ORR)为89.3%,疾病控制率(DCR)为95.7%;6、12、18、24个月总生存率分别为95.70%、76.40%、63.30%、58.00%。单因素分析及Cox比例风险回归显示:肿瘤边界不规整(RR=3.938,95%CI:1.709~9.073,P=0.005)和肿瘤位置临近危险区域(大血管、空腔脏器等)(RR=3.202,95%CI:1.415~7.245,P=0.001)与患者术后生存相关。结论TACE联合局部消融是治疗外科术后复发性肝癌的一种较为有效的治疗方式。肿瘤边界不完整和肿瘤位置临近危险区域(大血管、空腔脏器等)是影响此类患者术后生存的危险因素。

Objective To investigate the clinical effect of transcatheter arterial chemoembolization(TACE)combined with local ablation in the treatment of recurrent liver cancer after surgery,as well as the risk factors for prognosis.Methods A retrospective analysis was performed for the data of 47 patients with recurrent liver cancer after surgery who received TACE combined with local ablation in General Hospital of Ningxia Medical University from January 2017 to December 2020.The patients were followed up after local ablation to assess short-term outcome and survival.Univariate and multivariate analyses were used to investigate the factors affecting prognosis;the Kaplan-Meier model and the log-rank test were used for univariate analysis,and the Cox proportional-hazards regression model was used for multivariate analysis.Results At 3 months after treatment,the 47 patients with recurrent liver cancer after surgery had an overall effective rate of 89.3%and a disease control rate of 95.7%,and the overall survival rates at 6,12,18,and 24 months were 95.70%,76.40%,63.30%,and 58.00%,respectively.The univariate analysis and the Cox proportional-hazards regression analysis showed that irregularity of tumor boundary(risk ratio[RR]=3.938,95%confidence interval[CI]:1.709-9.073,P=0.005)and proximity of tumor to risk areas(major blood vessels and hollow visceral organs,etc.)(RR=3.202,95%CI:1.415-7.245,P=0.001)were associated with postoperative survival.Conclusion TACE combined with local ablation is an effective treatment modality for recurrent liver cancer after surgery,and irregularity of tumor boundary and proximity of tumor to risk areas(major blood vessels and hollow visceral organs,etc.)are the risk factors affecting the postoperative survival of such patients.