微波消融联合经肝动脉化疗栓塞术治疗原发性肝癌合并门静脉癌栓的效果及影响因素

目的探讨微波消融(MWA)联合经肝动脉化疗栓塞术(TACE)治疗原发性肝癌(PHC)合并门静脉癌栓(PVTT)的效果及主要影响因素。方法选取2016年1月-2018年3月成都市第七人民医院收治的PHC合并PVTT患者92例,其中接受MWA联合TACE治疗的患者为联合组(n=47),仅接受TACE治疗的为对照组(n=45)。观察2组患者治疗后短期疗效、生存情况、不良反应、并发症发生率,以及完全缓解(CR)、部分缓解(PR)、疾病稳定(SD)和疾病进展(PD);比较2组患者术后3个月治疗有效率(RR)。计量资料2组间比较采用t检验,计数资料2组间比较采用χ^2检验。用Kaplan-Meier法进行生存分析,log-rank检验对各项可能因素进行单因素分析,用Cox逐步回归方法进行多因素分析。结果治疗结束后3个月,联合组和对照组RR分别为42.2%和11.9%,差异有统计学意义(χ^2=8.679,P<0.05)。2组患者治疗后3d均出现发热、恶心呕吐和肝区疼痛等不良反应。联合组患者1、2、3年累积生存率分别为44.7%、23.4%、6.4%,对照组患者1、2、3年累积生存率分别为22.5%、8.9%、0,联合组中位生存时间(10.9个月)明显高于对照组(5.1个月),差异有统计学意义(χ^2=5.749,P<0.05)。术前AFP、肿瘤数目、肿瘤大小、癌栓分型、BCLC分期和Child-Pugh分级与合并PVTT的PHC患者的生存相关(χ^2值分别为9.356、7.641、11.352、9.764、8.236、17.392,P值均<0.05)。多因素分析显示,肿瘤大小、癌栓分型、BCLC分期是影响患者生存的独立因素风险比(95%可信区间)分别为1.997(1.608~3.145)、1.584(1.306~2.757)、1.690(1.035~2.683),P值均<0.05]。结论MWA联合TACE治疗PHC合并PVTT具有更好的安全性和有效性,影响患者预后的主要因素是肿瘤大小、癌栓分型、BCLC分期。

Clinical effect of microwave ablation combined with transcatheter arterial chemoembolization in treatment of primary hepatocellular carcinoma with portal vein tumor thrombus and related influencing factors

Objective To investigate the clinical effect of microwave ablation (MWA) combined with transcatheter arterial chemoembolization (TACE) in the treatment of primary hepatocellular carcinoma (PHC) with portal vein tumor thrombus (PVTT) and related influencing factors.Methods A total of 92 patients with PHC and PVTT who were admitted to Chengdu Seventh People's Hospital from January 2016 to March 2018 were enrolled,among whom 47 patients treated with MWA combined with TACE were enrolled as combined treatment group and 45 treated with TACE alone were enrolled as control group.The two groups were compared in terms of short-term outcome,survival,incidence rates of adverse reactions and complications,and rates of complete response (CR),partial response (PR),stable disease (SD),and progressive disease (PD),as well as response rate (RR) at 3 months after surgery (RR=CR+PR).The t -test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier method was used for survival analysis,the log-rank test was used for univariate analysis of possible factors,and a Cox stepwise regression analysis was used for multivariate analysis.Results At 3 months after the treatment ended,there was a significant difference in RR between the combined treatment group and the control group (42.2% vs 11.9%,χ^2=8.679,P <0.05).The adverse reactions such as pyrexia,nausea and vomiting,and liver area pain were observed in both groups.The combined treatment group had 1-,2-,and 3-year cumulative survival rates of 44.7%,23.4%,and 6.4%,respectively,and the control group had 1-,2-,and 3-year cumulative survival rates of 22.5%,8.9%,and 0,respectively.The combined treatment group had a significantly longer median survival time than the control group (10.9 months vs 5.1 months,χ^2=5.749,P <0.05).Preoperative alpha-fetoprotein,number of tumors,tumor size,type of PVTT,Barcelona Clinic Liver Cancer (BCLC) stage,and Child-Pugh class were associated with the survival of the patients with PHC and PVTT (χ^2 =9.356,7.641,11.352,9.764,8.236,and 17.392,all P <0.05).The multivariate analysis showed that tumor size (hazard ratioHR]=1.997,95% confidence interval CI]: 1.608-3.145,P <0.05),type of PVTT (HR=1.584,95%CI:1.306-2.757,P <0.05),BCLC stage (HR=1.690,95%CI:1.035-2.683,P <0.05) were independent influencing factors for survival.Conclusion MWA combined with TACE has good safety and efficacy in the treatment of patients with PHC and PVTT.Tumor size,type of PVTT,BCLC stage are the main influencing factors for prognosis.