DEB-TACE序贯微波消融术治疗原发性大肝癌患者临床疗效研究

Drug-eluting bead transcatheter arterial chemoembolization followed by microwave ablation in dealing with patients with large primary liver cancer

目的探讨采用载药栓塞微球经肝动脉化疗栓塞(DEB-TACE)序贯微波消融(MWA)术治疗原发性大肝癌(PLC)患者的临床疗效。方法2018年5月~2021年5月我院收治的50例PLC患者,纳入患者肝内肿瘤直径大于5 cm。采用随机数字表法将患者分为对照组25例和观察组25例,分别接受常规TACE序贯MWA治疗或DEB-TACE序贯MWA术治疗。常规检测血清甲胎蛋白(AFP)和甲胎蛋白异质体(AFP-L3)。随访评估完全缓解(CR)、部分缓解(PR)、疾病稳定、疾病进展(PD),统计客观缓解率(ORR)、疾病控制率(DCR)、无进展生存期(PFS)和总生存期(OS)。结果治疗后,观察组CR、PR、SD、ORR和CDR分别为44.0%、48.0%、4.0%、92.0%和96.0%,显著优于对照组(分别为36.0%、24.0%、16.0%、60.0%和76.0%,P<0.05);治疗后观察组血清AFP和AFP-L3水平分别为(121.5±63.7)ng/mL和(7.1±0.2)%,均显著低于对照组【分别为(434.9±68.5)ng/mL和(13.6±0.4)%,P<0.05】;治疗后随访(18.3±6.7)个月,观察组病死率为24.0%,与对照组的48.0%比,差异无显著性统计学意义(x^(2)=3.125,P=0.077);观察组和对照组中位PFS分别是8.3个月和5.3个月(t=3.172,P=0.075),中位OS分别是14.5个月和9.4个月(t=2.432,P=0.082),无显著性差异。结论采用DEB-TACE序贯MWA术治疗大肝癌患者可能临床近期疗效稍好,但远期疗效还需要进一步研究。

Objective The purpose of this study was to investigate the clinical efficacy of drug-eluting bead transcatheter arterial chemoembolization(DEB-TACE)followed by microwave ablation(MWA)in dealing with patients with large primary liver cancer(PLC).Method 50 consecutive patients with large PLC were encountered in our hospital between May 2018 and May 2021,and were randomly divided into control and observation group,with 25 cases in each group.The patients in the control group was treated with conventional TACE and thereafter MWA,and the patients in the observation received DEB-TACE followed by MWA.All patients were followed-up and the efficacy was evaluated by complete remission(CR),partial remission(PR),stable disease(SD),progressive disease(PD),objective remission rate(ORR),disease control rate(DCR),progression-free survival(PFS)and overall survival(OS).Results After treatment,the CR,PR,SD,ORR and CDR in the observation group were 44.0%,48.0%,4.0%,92.0%and 96.0%,much superior to 36.0%,24.0%,16.0%,60.0%and 76.0%(P<0.05)in the control;serum AFP and AFP-L3 levels in the observation were(121.5±63.7)ng/mL and(7.1±0.2)%,both much lower than[(434.9±68.5)ng/mL and(13.6±0.4)%,respectively,P<0.05]in the control;after(18.3±6.7)month of follow-up after treatment,the fatality rate in the observation group was 24.0%,not significantly different compared to 48.0%in the control(x^(2)=3.125,P=0.077);the median PFS in the observation and in the control were 8.3 mon and 5.3 mon(t=3.172,P=0.075),and the median OS in the two groups were 14.5 mon and 9.4 mon(t=2.432,P=0.082),not significantly different.Conclusion The short-term efficacy of DEB-TACE and MWA combination in treatment of patients with large PLC is definite,while the long-term efficacy should investigate further in the future.