TACE联合微波消融对比单独TACE治疗＞5cm原发性肝癌的倾向性匹配分析

目的 对比肝动脉化疗栓塞(TACE)联合微波消融(MWA)与单独TACE治疗＞5 cm原发性肝癌的临床疗效.方法 回顾性分析2014年6月至2015年12月,208例原发性肝癌患者的临床资料,其中TACE联合MWA组40例、TACE组168例,按1∶1进行配对后分析两种治疗方式的临床效果.首要观察指标是患者的生存期,次要观察指标是1个月的改良实体瘤反应(mRECIST标准)和AFP下降水平.结果 实际配对完成患者31对,配对后组间基线资料具有可比性.结果显示TACE联合MWA的0.5、1、1.5、2和2.5年生存率分别为96.8％、90.3％、86.8％、82.5％和70.7％,明显优于TACE组的77.4％、61.3％、53.6％、48.2％和24.1％(P=0.011).联合治疗组在1个月时有更好的肿瘤控制和AFP下降水平.两组均无严重并发症发生.结论 TACE联合MWA对于＞5 cm肝癌的治疗在患者生存和肿瘤控制方面要优于单独TACE治疗.

TACE combined with microwave ablation versus pure TACE for hepatocellular carcinomas larger than five cm in diameter: a propensity matching analysis

Objective To compare the curative effect of transarterial chemoembolization (TACE)plus microwave ablation (MWA) with that of pure TACE in treating hepatocellular carcinoma (HCC) larger than 5 cm in diameter.Methods The clinical data of 208 patients with HCC,who were admitted to authors' hospital to receive treatment during the period from June 2014 to December 2015,were retrospectively analyzed.The patients were divided into combination group (n=40,treated with TACE+MWA) and TACE group (n=168,treated with TACE only).By using 1 ∶ 1 pairing,the curative results of the two groups were analyzed.The survival of patient was taken as the primary observation index,and both the one-month solidtumor response value determined with modified Response Evaluation Criteria in Solid Tumors (mRECIST)and the reduction in AFP level were the secondary observation indexes.Results A total of 31 pairings were accomplished.The baseline data of the paired groups were comparable.The results indicated that half-,one-,1.5-,2-and 2.5-year survival rates in the combination group were 96.8％,90.3％,86.8％,82.5％ and 70.7％ respectively,which were significantly better than those of 77.4％,61.3％,53.6％,48.2％ and 24.1％ respectively in the TACE group (P=0.011).The one-month tumor-control rate and the reduction degree in AFP level of the combination group were better than those of the TACE group.No severe complications occurred in both groups.Conclusion For the treatment of HCC that is larger than 5 cm in diameter,TACE combined with MWA is superior to pure TACE in increasing survival rate as well as in improving tumor-control rate.