射频消融联合经导管肝动脉栓塞化疗治疗肝癌疗效分析

目的 分析射频消融(RFA)联合经导管肝动脉栓塞化疗(TACE)治疗原发性肝癌的近期和远期疗效.方法 回顾性分析中山大学肿瘤防治中心肝胆外科2000年9月至2007年8月临床诊断为原发性肝细胞性肝癌114例,并行射频消融联合导管肝动脉栓塞化疗,对其进行生存分析.结果 全部病例1、2、3、4、5年总体生存率分别为90.4%、82.6%、73.2%、63.5%、49.1%、1、2、3、4、5年肿瘤无进展生存率分别为:77.1%、64.6%、54.6%、46.8%、36.4%.其中,病灶最大直径≤5 cm和5.1～7cm的1、2、3、4、5年生存率分别为95.5%、84.6%、73.1%、61.5%、50.6%及80.2%、64.9%、56.3%、45.3%、39.5%(P=0.041),单个病灶和多个(不多于3个病灶)病灶的1、2、3、4、5年生存率分另4为95.8%、89.1%、78.1%、67.1%、56.7%及80.0%、60.6%、46.6%、33.4%、21.5%(P=0.001).结论 RFA联合TACE是一种治疗肝癌的有效方法,直径≤5 cm、单个病灶的肝癌效果明显好于直径5.1～7 cm、多个病灶的肝癌.白蛋白水平、甲胎蛋白水平、肿瘤病灶边界是否清楚及病灶数目是影响联合治疗疗效的预后因素.

Effectiveness of radiofrequency ablation combined with transcatheter arterial chemoembolization for hepatocellular carcinoma

Objective To analyze the short-term and long-term effectiveness of radiofrequency ablation(RFA)combined with transcatheter arterial chemoembolization(TACE)in the treatment of hepatocellular carcinoma(HCC).Methotis The clinical data of 114 HCC patients,104 males and 10 females,aged 55(30-81),treated by RFA combined with TACE and followed up for 20(1-82)months were analyzed.Results Complete necrosis was achieved in 101 patients(88.6%).10 patients showed incomplete necrosis and 3 patients showed new neoplasm.and they all underwent repeated RFA or TACE.No therapy-relative death was found.The overall 1-,2-,3-,4-,and 5-year survival rates were 90.4%,82.6%,73.2%,63.5%,and 49.1% respectively.The 1-,2-,3-,4-,and 5-year tumor progression-free survival rates were 77.1%,64.6%,54.6%,46.8%,and 36.4% respectively.The overall 1-,2-,3-,4-,and 5-year survival rates for the tumors with the size≤5 em and the tumors with the size of 5.1-7 cm were 95.5%,84.6%,73.1%,61.5%,and 50.6% and 80.2%,64.9%,56.3%,45.3%,and 39.5% respectively(P=0.041).The overall 1-,2-,3-,4-,and 5-year survival rates for the solitary tumor and multiple tumors(no more than 3 tumors)were 95.8%,89.1%,78.1%,67.1%,and 56.7% and 80.0%,60.6%,46.6%,33.4%,and 21.5% respectively(P=0.001).The levels of albumin and α-fetoprotein,and boundary and number of tumors were proved to be independent risk factors of survival.Conclusion RFA combined with TACE is an effective treatment for HCC with satisfactory short-term and long-term effects,especially for the patients with tumor of the size of 5.1-7 cm or multiple lesions.