摘要
目的评价单独进行TACE与TACE联合RFA两种方法治疗的肝细胞痛合并单支门静脉癌栓的可行性、安伞性、局部控制率及远期生存状况，并分析其预后因素。方法2004年1月至2007年12月，中山大学肿瘤防治中心人组50例肝内病变最大直径〈5cm、数目〈3个合并有单支门脉癌栓的肝细胞癌患者（TACE组25例，TACE-RFA组25例），对肝内病灶采取TACE联合RFA治疗，对两组的癌栓分别予以单独TACE和TACE联合RFA治疗，通过CT扫描和AFP水平测定进行随访。两组病例的生存状况分析采用Kaplan-Meier法，以Cox回归模型进行多元预后因素分析。结果在人组的50例患者中，47例有完整的治疗和随访结果。安全性方面，TACE组有2例（8．3％）患者治疗后发牛肝功能损害；在TACE-RFA组，没有患者发生肝功能损害，有2例（8．7％）发牛与RFA治疗相关的胆管损伤。3个月后的随访结果，TACE组有效率为54．2％（CR8．3％，PR45．8％），TACE-RFA组有效率为87．0％（CR60．9％，PR26．1％）（P〈0．05）。从HCC确诊时计算，’FACE组中位生存期为9个月，1、2、3年生存率分别为33．3％，12．5％，8．3％，TACE．RFA组相应的数据为26个月，65．2％、47．8％、30．4％（P〈0．05）。从门静脉癌栓确诊时开始计算，TACE组相应的数据为7个月，12．5％、4．2％、0；TACE-RFA为22个月，52．2％、34．8％、8．7％（P〈0．01）。预后因素方面，只有治疗方式的不同在多元分析中有意义。结论TACE联合RFA对肝内肝细胞癌灶得到控制的单支门脉癌栓的治疗安全有效，可以延长患者的牛存期限。在治疗门静脉癌栓方面，TACE联合RFA可以为以后深入研究提供参考。
Objective To compare the transcatheter arterial chemoembolization （TACE） alone or plus radiofrequency ablation （RFA） in the treatment of single branch portal vein tumor thrombus（PVTT）in patients with hepatocellular carcinoma （HCC） so as to evaluate the safety, control rate, prognostic factors and overall survival. Methods From January 2004 to December 2007, 50 HCC patients （ 〈 5 cm in diameter and 3 parenchymal lesions ） with concurrent PVTT were enrolled and treated by TACE alone or TACE plus RFA randomly （ TACE, n = 25 ; TACE-RFA, n = 25 ）. In TACE group, the intra-hepatic lesions received TACE sequentially with RFA; in TACE-RFA group, PVTF and intra-hepatic lesions were treated with TACE sequentially with RFA separately. Strict follow-up was conducted by computed tomography and alpha-fetoprotein （AFP） assay. The survival time was analyzed by the Kaplan-Meier method and Cox regression analysis was performed to evaluate the prognostic factors. Results Of all 50 HCC patients with single branch PVTr with TACE or RFA, 47 patients （TACE, n = 24 ; TACE-RFA, n = 23） received all the scheduled procedures and completed the follow-up. Two patients （8.3%） in TACE group had liver dysfunction versus none in TACE-RFA group, 2 patients （8.7%） developed bile duct injury in TACE-RFAgroup related with the RFA procedure. The OR （overall response ） for PVTT was 54. 2% （complete response （CR） 8. 3%, partial response （PR） 45.8% ） in TACE group while 87.0% （CR 60. 9%, PR 26. 1% ） in TACE-RFA group during the follow-up. From the definite diagnosis of HCC, the median survival was 8 months. And the 1-, 2- ＆ 3-year survival rates were 33.3% , 12. 5% , 8.3% in TACE group. And 26 months, 65.2% , 47.8% , 30. 4% in TACE-RFA group respectively. The difference between two groups was significant. From the definite diagnosis of PVTY, the respective data were 7 months, 12. 5% and 4. 2% , 0 in TACE group versus 22 months, 52. 2% , 34. 8% , and 8. 7% in TACE-RFA group with a significant P value. In multivariate analysis, only therapy （TACE or TACE-RFA） showed a protective value （ hazard rate 0. 430 vs 0. 345, P 〈 0.05 ）. Survival was not correlated with age, intra-hepatic tumor status, liver functions and AFP level for all patients. Conclusion RFA is both safe and efficacious to prolong survival in the treatment of single branch PVTT plus TACE in selected HCC patients. It may provide rationales for further studies of evaluating the outcome of RFA plus other therapies in the treatment of HCC with single branch PVTT.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2011年第17期1167-1172,共6页
National Medical Journal of China
关键词
癌
肝细胞
射频消融术
药物疗法
联合
癌栓
Carcinoma, hepatocelluar
Radiofrequency ablation
Drug therapy, combination
Tumor thrombus
