原发性肝癌综合介入治疗的疗效分析

目的探讨原发性肝癌综合介入治疗的疗效。方法回顾性分析1126例原发性肝癌患者手术前后行经导管肝动脉化疗栓塞术(TACE)、TACE后射频消融(RFA)治疗、TACE或经导管肝动脉化疗灌注治疗(TAI)后辅以中药和生物治疗的临床资料,分析患者肝功能、肿瘤标志物、癌灶影像资料和生存率等,比较各种综合介入治疗的价值。结果全组患者1、3、5年生存率分别为67.8%、28.7%和18.8%。其中术前TACE组1、3、5年生存率分别为74.7%、41.4%和36.9%,术后TACE组1、3、5年生存率分别为78.9%、40.4%和37.5%;TACE RFA组的近期有效率为93.4%,1、3年生存率分别为74.5%和36.8%;TACE组的近期有效率为83.2%,1、3、5年生存率分别为69.3%、21.7%和8.4%;TAI治疗的近期有效率为27.5%,1、3年生存率分别为11.6%和0。TACE RFA组和TACE组间肝功能Child降级、瘤内与瘤周血流信号消失和甲胎蛋白转阴率差异均无统计学意义,TACE RFA组、TACE组与TAI组肝功能Child降级差异无统计学意义。结论原发性肝癌手术切除前后TACE效果最佳,手术前与手术后行TACE疗效相近;TACE RFA疗效优于TACE;TAI疗效较差。

Comparision of different interventional therapies for primary liver cancer

Objective To investigate the efficacy of different interventional therapies for primary hepatic cell cancer (HCC). Methods 1126 HCC patients before or after hepatectomy were treated by different kinds of interventional therapies: transcatheter arterial chemoembolization (TACE), TACE and radio-frequency ablation (RFA), Chinese traditional medicine and biotherapy after TACE or the transcatheter arterial infusion (TAI). The results of liver function, alpha-fetoprotein, imaging, color-ultrasonography and survival rate were reviewed. Results 874 patients were followed up for 2 to 63 months. The overall 1 -, 3-, 5-year survival rate was 67. 8% , 28.7% and 18. 8% , respectively. The 1 -, 3-, 5-year survival rate of patients who received TACE before hepatectomy was 74. 7% , 41. 4% and 36. 9% ; after hepatectomy 78.9% , 40.4% and 37.5% , respectively. The response rate ( PR NC) of TACE and RFA was 93.4% , and the 1-, 3-year survival rate was 74. 5% and 36. 8% , respectively, after TACE and RFA. The response rate ( PR NC) of TACE was 83. 2% with 1-, 3-, 5-year survival rate of 69. 3% , 21. 7% , 8.4% after TACE, respectively. The response rate (PR NC) of TAI was 27.5% with 1-, 2-year survival rate of 11. 6% and 0 after TAI. The Child grade of liver function, color-ultrasonography and alpha-fetoprotein of TACE RFA group, TACE and TAI were compared. There was no significant difference between each above mentioned index among TACE, RFA or TACE groups. Conclusion Compared with other modalities, transcatheter arterial chemoembolization (TACE) before or after hepatectomy is more effective than other interventional therapies for primary hepatocellular cancer, whereas, if combined with radio-frequency ablation (TAI), it is much more effective than TACE alone.