经肝动脉化疗栓塞术联合局部热消融治疗大肝癌的效果及影响因素

目的探讨经肝动脉化疗栓塞术(TACE)联合局部热消融治疗大肝癌的临床效果。方法回顾性分析2010年1月-2016年9月在首都医科大学附属北京佑安医院肿瘤微创介入中心接受TACE联合局部热消融治疗的大肝癌患者的临床资料,134例患者中行TACE联合微波消融治疗75例,行TACE联合射频消融治疗共59例。评价患者的消融效果(分为完全消融和部分消融),随访获得完全消融的患者肝内肿瘤复发状况。采用χ2检验和logistic回归分析消融效果的影响因素;采用Kaplan-Meier生存分析和Cox比例风险模型统计其中位无复发生存期并分析影响因素。结果在全部患者中,有88例获得完全消融,46例为部分消融,完全消融率为65. 7%,logistic回归分析分析显示,合并门静脉癌栓比值比(OR)=5. 051,P=0. 017],肿瘤包膜不完整(OR=4.199,P=0. 007)及肿瘤位于危险部位(OR=4. 967,P=0. 001)是影响消融效果的独立危险因素。获得完全消融的患者其中位无复发生存期是(17. 41±2. 73)个月,1、3、5年的无复发生存率分别为61. 4%、23. 3%和17. 7%,多因素分析显示,肿瘤多发(OR=1. 708,P=0. 041)是其独立危险因素。TACE联合微波消融和TACE联合射频消融2种治疗方式对消融效果(χ2=2. 431,P=0. 119)和肿瘤复发(χ2=3. 292,P=0. 070)的影响差异均无统计学意义。结论合并门静脉癌栓、肿瘤包膜的完整性和肿瘤部位是大肝癌患者消融效果的影响因素,对于获得完全消融的患者,肿瘤数目可用于评估肿瘤复发的危险性。

Clinical effect of transcatheter arterial chemoembolization combined with local thermal ablation in treatment of large hepatocellular carcinoma and related influencing factors

Objective To investigate the clinical effect of transcatheter arterial chemoembolization( TACE) combined with local thermal ablation in the treatment of large hepatocellular carcinoma( HCC). Methods A retrospective analysis was performed for the clinical data of134 patients with large HCC who underwent TACE combined with local thermal ablation in our center from January 2010 to September 2016.In all patients,75 underwent TACE combined with microwave ablation and 59 underwent TACE combined with radiofrequency ablation. The effect of ablation( complete ablation and partial ablation) was evaluated,and follow-up was performed to observe the recurrence of intrahepatic tumor in patients with complete ablation. The chi-square test and logistic regression analysis were used to evaluate the influencing factors for the effect of ablation,and the Kaplan-Meier survival analysis and the Cox proportional hazards model were used to analyze recurrence-free survival and related influencing factors. Results Of all patients,88 achieved complete ablation and 46 patients achieved partial ablation,resulting in a complete ablation rate of 65. 7%. The logistic regression analysis showed that presence of portal vein tumor thrombus( odds ratio OR]= 5. 051,P = 0. 017),incomplete tumor capsule( OR = 4. 199,P = 0. 007),and dangerous location of tumor( OR =4. 967,P = 0. 001) were independent risk factors for the effect of ablation. The patients with complete ablation had a median recurrence-free survival of 17. 41 ± 2. 73 months and the 1-,3-,and 5-year recurrence-free survival rates were 61. 4%,23. 3%,and 17. 7%,respectively; the multivariate analysis showed that multiple tumors( OR = 1. 708,P = 0. 041) was an independent risk factor. There were no significant differences between TACE combined with microwave ablation and TACE combined with radiofrequency ablation in the effect of ablation( χ^2= 2. 431,P = 0. 119) and tumor recurrence( χ^2= 3. 292,P = 0. 070). Conclusion Presence of portal vein tumor thrombus,tumor capsule integrity,and tumor location are important influencing factors for the effect of ablation in patients with large HCC. For patients with complete ablation,the number of tumors can be used to assess the risk of intrahepatic tumor recurrence.