微波消融术联合肝动脉介入栓塞术治疗肝细胞癌的临床研究

目的：比较微波消融术（ microwave ablation，MWA）联合或者不联合经肝动脉化疗栓塞术（ transcathe-ter arterial chemoembolization，TACE）治疗肝细胞癌（ HCC）的临床疗效以及不良反应。方法：选择89例2006年10月至2009年7月入我院治疗的肿瘤直径≤5cm的原发性肝细胞癌患者，采用随机数字法分为MWA联合TACE组（n=44）或者单独MWA组（n=45）进行随机对照研究，观察两组患者的总生存率（OS）、无复发生存率（ RFS）以及不良反应。结果：所有患者均治疗成功，随访时间为7-62个月，随访结束时联合组患者死亡15人，微波组死亡23人。联合组、微波组分别有16人、25人出现疾病进展。1年、2年、3年OS分别为86.4%，74.4%，61.8%和77.4%，63.6%，50.0%。对应的RFS为72.4%，61.6%，45.8%和61.7%，52.2%，39.8%。联合组的OS以及RFS高于单纯微波组（风险比率HR为0.323，95%CI为0.295-0.351，P=0.002；风险比率HR为0.258，95%CI为0.230-0.286，P=0.02）。研究过程中无治疗相关性死亡。对相关因素进行Logistic回归分析，治疗分配、肿瘤大小、肿瘤数目是OS相关预后因素，治疗分配、肿瘤大小是RFS相关预后因子。结论：MWA联合TACE术治疗病灶≤5cm的HCC患者疗效优于单独的MWA治疗疗效。

Clinical research of microwave ablation plus transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma

Objective：To compare microwave ablation（ MWA）with or without transcatheter arterial chemoemboli-zation（ TACE）in the treatment of hepatocellular carcinoma（ HCC）. Methods：The research was conducted on 89 pa-tients with HCC less than 5cm received treatment in our hospital between October 2006 and July 2009. They were ran-domly assigned to recesive MWA combined with TACE（n=44）or MWA alone（n=45）. The end point were overall survival（ OS）、recurrence-free（ RFS）and adverseeffects. Results：Technical success was achieved in all patients,at a follow-up of 7 to 62 months,15 patients in the MWA-TACE group and 23 patients in the MWA group had died. 16 patients and 25 patients had developed recurrence in the MWA-TACE group and MWA group,respectively. The 1-,2-,and3-year overall survivals for the MWA-TACE group and the MWA group were 86. 4%,74. 4%,61. 8% and 77. 4%,63. 6%,50. 0%,respectively. The corresponding recurrence-free survival were 72. 4%,61. 6%,45. 8%and 61. 7%,52. 2%,39. 8%. Patients in the MWA-TACE group had better overall survival and recurrence - free survival than patients in the MWA group（ hazard ratio ,0. 323;95%CI：0. 295 to 0. 351;P=0. 002;hazard ratio, 0. 258;95%CI：0. 230 to 0. 286;P=0. 02）. There were no treatment-related deaths. On Logistic regression analy-ses,treatment allocation and tumor size were significant prognostic factors for recurrence-free survival. Conclusion：MWA-TACE was superior to MWA alone in improving survival for patients with HCC less than 5cm.