经肝动脉化疗栓塞术联合微波消融与重复肝切除术治疗复发性肝细胞癌的效果比较

Clinical effect of transcatheter arterial chemoembolization combined with microwave ablation versus repeat resection in treatment of recurrent hepatocellular carcinoma

目的比较经肝动脉化疗栓塞(TACE)联合微波消融(MWA)(TACE-MWA)与重复肝切除术(RR)治疗复发性肝细胞癌(RHCC)的效果。方法选取2015年6月1日—2020年9月30日内江市第二人民医院收治的178例RHCC患者,按治疗方式不同分为RR组(n=64例)和TACE-MWA组(n=114)。记录治疗前基线人口学资料、肝功能及肿瘤相关情况等。随访至2021年10月,比较两组患者术后总生存期(OS)和无复发生存期(RFS)。进行基于复发模式(复发时间和肿瘤大小)的亚组分析,并研究预后的影响因素。计量资料两组间比较采用独立样本t检验,计数资料两组间比较采用χ^(2)检验;术后生存率用Kaplan-Meier法,两组间生存差异用Log-rank检验;使用Cox多因素分析方法探寻影响生存的独立危险因素。结果多因素分析显示,肿瘤直径、AFP水平、ALT、Alb和复发时间是OS的独立预后因素(P值均<0.05),AFP水平和复发时间是RFS的独立预后因素(P值均<0.05)。对于晚期复发(>2年)的RHCC,RR组与TACE-MWA组之间的中位OS有显著差异(54.0个月vs 36.0个月,χ^(2)=6.171,P=0.013),中位RFS也有显著差异(28.0个月vs 21.0个月,χ^(2)=5.211,P=0.022)。对于肿瘤直径≤5 cm的RHCC,两组的中位OS有显著差异(33.0个月vs 27.0个月,χ^(2)=6.447,P=0.011)。结论对于早期复发或肿瘤直径>5 cm的RHCC,RR与TACE-MWA有相似的疗效,但对于晚期复发或肿瘤直径≤5 cm的RHCC,RR应为首选。

Objective To investigate the clinical effect of transcatheter arterial chemoembolization(TACE)combined with microwave ablation(MWA)(TACE-MWA)versus repeat resection(RR)in the treatment of recurrent hepatocellular carcinoma(RHCC).Methods A total of 178 patients with RHCC who were admitted to The Second People’s Hospital of Neijiang from June 2015 to September 2020 were enrolled,and according to the treatment modality,they were divided into RR group with 64 patients and TACE-MWA group with 114 patients.Baseline demographic data,liver function,and tumor conditions before treatment were recorded,and the patients were followed up to October 2021 to compare postoperative overall survival(OS)time and recurrence-free survival(RFS)time between the two groups.Subgroup analysis based on recurrence pattern(recurrence time and tumor size)was performed,and the influencing factors for prognosis were analyzed.The independent samples t-test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data;the Kaplan-Meier method was used for postoperative survival rate,the Log-rank test was used for survival difference analysis,and a multivariate Cox regression analysis was used to investigate independent risk factors for survival.Results The multivariate analysis showed that tumor diameter,alpha-fetoprotein(AFP)level,alanine aminotransferase,albumin,and time to recurrence were independent prognostic factors for OS(all P<0.05),and AFP level and time to recurrence were independent prognostic factors for RFS(both P<0.05).For RHCC with late recurrence(>2 years),there were significant differences between the two groups in median OS(54.0 months vs 36.0 months,χ^(2)=6.171,P=0.013)and median RFS(28.0 months vs 21.0 months,χ^(2)=5.211,P=0.022).For RHCC with a tumor diameter of≤5 cm,there was a significant difference in median OS between the two groups(33.0 months vs 27.0 months,χ^(2)=6.447,P=0.011).Conclusion RR has a similar clinical effect to TACE-MWA in RHCC with early recurrence or a tumor diameter of>5 cm,but RR should be the first choice for RHCC with late recurrence or a tumor diameter of≤5 cm.