栓塞化疗及射频的序贯应用对大肝癌术后复发防治的价值

目的探讨术后栓塞化疗（TACE）和射频消融（RFA）的序贯应用对大肝癌术后复发的防治效果。 方法回顾性分析2004年1月至2015年12月中山市人民医院大肝癌手术切除113例，其中术后53例行TACE（TACE组），34例行TACE和RFA（TACE+RFA组），26例行单纯手术切除治疗（单纯切除组）。以术后总体生存期，术后1、3、5年生存率，术后1、2、3年复发率等指标评价3组患者的中远期疗效。 结果(1)TACE组、TACE+RFA组和单纯切除组患者的中位生存时间分别为39.0、49.0、29.0个月，TACE+RFA组中位生存时间最长，单纯切除组最短（χ²=12.5，P=0.002）。(2)TACE组术后1、3、5年生存率分别为86.8%、62.2%、34.0%，TACE+RFA组为82.3%、55.8%、41.1%，单纯手术组为76.9%、34.6%、19.2%，3组患者术后3、5年生存率差异有统计学意义，远期生存率以TACE+RFA组为最高（P<0.05）。(3)TACE组术后1、2、3年复发率分别为15.1%、33.9%、62.2%，TACE+RFA组为29.4%、55.9%、70.5%，单纯手术组为23.1%、42.3%、80.7%。单纯切除组3年复发率明显高于术后TACE组及TACE+RFA组，所有年复发率以术后TACE组为最低，差异有统计学意义（P<0.05）。 结论术后TACE可预防大肝癌术后中、远期复发，而TACE联合RFA的序贯性应用能明显改善大肝癌术后复发的预后。

Prevention and treatment value of sequential application of transcathater arterial chemoembolization and radiofrequency for recurrence of large hepatocellular carcinoma

ObjectiveTo investigate the value of sequential implications of transcathater arterial chemoembolization (TACE) and radiofrequency ablation (RFA) for postoperative recurrence of large hepatocellular carcinoma. MethodsFrom January 2004 to December 2015, one hundred and thirteen cases undergoing liver cancer resection in Zhongshan City People’s Hospital were analyzed retrospectively. TACE was performed in 53 cases after operation (TACE group), TACE+RFA in 34 cases (TACE+RFA group), and 26 cases were treated with simple resection (simple resection group). The overall survival, postoperative 1-, 3-, 5-year survival rates, 1-, 2-, 3-year recurrence rates were used to evaluate the long-term effects of the three groups. Results(1) The median survival time was 39.0, 49.0, 29.0 months in TACE group, TACE+RFA group and simple resection group, respectively. The median survival time of TACE+RFA group was the longest, and the simple resection group was the shortest (χ²=12.5, P=0.002). (2) The 1-, 3- and 5-year survival rates in TACE group were 86.8%, 62.2% and 34.0%, respectively; 82.3%, 55.8% and 41.1% in TACE+RFA group, while those in simple resection group were 76.9%, 34.6% and 19.2% respectively. The 3-, 5-year survival rates of the 3 groups were statistically significant, and the long-term survival rate was the highest in the TACE+RFA group (P<0.05). (3) The 1-, 2-, and 3-year recurrence rate was 15.1%, 33.9% and 62.2% in TACE group; 29.4%, 55.9% and 70.5% in TACE+RFA group; 23.1%, 42.3% and 80.7% in simple resection group, respectively. The 3-year recurrence rate in simple resection group was significantly higher than the other two groups, and all the annual recurrence rates were the lowest in TACE group after operation (P<0.05). ConclusionsPostoperative TACE can prevent middle and long term recurrence of large liver carcinoma after operation. The sequential application of TACE combined with RFA can significantly improve the prognosis of large hepatocellular carcinoma with postoperative recurrence.