摘要
目的分析^125I放射性粒子植入联合肝动脉化疗栓塞(TACE)序贯射频消融(RFA)方案治疗包膜下肝癌结节的临床疗效及安全性。方法回顾分析2010年1月至2016年12月丽水市中心医院76例包膜下(肝包膜下<1cm)中晚期肝癌患者资料。男68例、女8例,年龄33~78(58±9)岁,肿瘤最大径3.1~12.0(5.7±2.3)cm,Child-Pugh A级28例,Child-Pugh B级48例,BCLC B期29例,C期47例。按照治疗方式分为两组,其中38例(TACE+RFA组)行TACE序贯RFA治疗,38例(^125I+TACE+RFA组)在TACE序贯RFA治疗后,行^125I放射性粒子植入术。分别计算中位生存时间及肿瘤无进展时间,评价两组患者的肿瘤控制有效率及不良反应。结果TACE+RFA组和^125I+TACE+RFA组患者肿瘤有效控制率分别为63.2%(24/38)和84.2%(32/38),(x^2=4.34,P=0.04);肿瘤无进展时间中位值为11和18个月(x^2=4.84,P=0.03),^125I+TACE+RFA组在6个月(94.7%±3.6%比81.3%±6.4%,Z=24.1>2.58,P=0.00)、1年(89.2%±5.1%比40.7%±8.3%,Z=13.3>2.58,P=0.00)、2年(55.9%±8.6%比29.6%±8.2%,Z=7.2>2.58.P=0.00)的累计肿瘤无进展率高于TACE+RFA组。^125I+TACE+RFA组和TACE+RFA组的生存时间中位值为42和30个月(x^2=4.76,P=0.029)。^125I+TACE+RFA组在1年(92.1%±4.4%比83.8%±6.1%,Z=23.5>2.58,P=0.00)、2年(75.8%.±7.0%比59.8%±8.4%,Z=12.43>2.58.P=0.00)、3年(59.0%±8.2%比41.7%±8.9%,Z=8.3>2.58,P=0.00)、5年(34.2%±8.2%比18.2%±8.1%,Z=5.5>2.58,P=0.00)的累计生存率高于TACE+RFA组。TACE+RFA组和^125I+TACE+RFA组术后肝功能、并发症差异无统计学意义。结论^125I放射性粒子植入能够提高TACE序贯RFA治疗中晚期包膜下肝癌的疗效,是一种有效的、安全的中晚期肝癌治疗方法。
Objective To analyze the clinical efficacy and safety of ^125I radioactive seed implantation in the treatment of sub-capsular hepatocellular carcinoma (sub-HCC) with sequential radiofrequency ablation and transcatheter arterial chemoembolization (TACE).Methods The clinical data of 76 cases with advanced HCC with sub-capsular nodules including 68 males and 8 females,with an average age of (58±9)years,ranging from 33 to 78 years,enrolled in Lishui Central Hospital from January 2010 to December 2016 were collected.The average maximum diameter of tumor is (5.7±2.3)cm,ranging from 3.1cm to 12.0cm.The patients were divided into TACE +RFA group and ^125I +TACE +RFA group with 38 cases in each group.The overall survival (OS)and progression free survival(PFS)were calculated.The clinical efficiency and adverse events were evaluated.Results The disease control rate were 84.2%(32/ 38)in ^125I+TACE +RFA group and 63.2%(24/38)in TACE +RFA group,χ^2=4.34,P =0.04.The median PFS were 18 months in ^125I +TACE +RFA group and 11 months in TACE +RFA group,χ^2=4.84, P =0.03.The FPS cumulative rate in ^125I +TACE +RFA group were higher than that in TACE +RFA group at 6 months (94.7%±3.6% vs 81.3%±6.4%,Z=24.1>2.58,P=0.00),1 year (89.2%±5.1% vs 40.7%±8.3%,Z=13.3>2.58,P =0.00)and 2 year (55.9%±8.6% vs 29.6%±8.2%,Z=7.2> 2.58,P =0.00).The median OS were 42 months in ^125I +TACE +RFA group and 30 months in TACE + RFA group,χ^2 =4.76,P =0.029.The survival cumulative rate in ^125I+TACE +RFA group were higher than that in TACE+RFA group at 1 year (92.1%±4.4%vs 83.8%±6.1%,Z=23.5>2.58,P= 0.00),2 year (75.8%±7.0% vs 59.8%±8.4%,Z =12.43>2.58,P =0.00),3 year (59.0%±8.2% vs 41.7%±8.9%,Z=8.3>2.58,P=0.00),5 year (34.2%±8.2% vs 18.2%±8.1%,Z= 5.5>2.58,P =0.00).In addition,there was no statistical difference in liver function and complications between TACE +RFA group and ^125I +TACE +RFA group.Conclusion ^125I radioactive seed implantation plus TACE combined with RFA treatment is an effective and safe treatment for sub-capsular hepatoce
作者
方世记
高瑞杰
郑丽云
赵中伟
范晓希
宋晶晶
张登科
吴发宗
纪建松
Fang Shiji;Gao Ruijie;Zheng Liyun;Zhao Zhongwei;Fan Xiaoxi;Song Jingjing;Zhang Dengke;Wu Fazong;Ji Jiansong(Department of Interventional Radiology,Lishui Hospital of Zhejiang University,the Fifth Affiliated Hospital of Wenzhou Medical University,Lishui Municipal Central Hospital,Lishui 323000,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2018年第47期3853-3857,共5页
National Medical Journal of China
基金
国家自然科学基金(81573657)
浙江省重大科技专项(2013C03010)
浙江省科技厅公益性技术应用研究计划项目(2016C37101).
关键词
肝肿瘤
碘同位素
药物疗法
联合
Liver neoplasms
Iodine isotopes
Drug therapy
combination
