摘要
背景与目的:对于复发性肝细胞癌(HCC),肝移植和重复肝切除是主要的治疗方法,但两者均有各自的局限性,不能适用于所有患者。此外,经导管动脉化疗栓塞(TACE)与经皮微波消融(PMCT)也是治疗复发性HCC的有效方法,但TACE联合PMCT是否更能提高治疗效果尚未见报道,故本研究通过回顾性分析,对TACE联合PMCT与单纯TACE治疗复发性HCC的远期疗效进行比较。方法:按纳入标准收集2007年1月—2019年1月西南医科大学附属医院肝胆外科收治的术后首次复发的530例HCC患者资料,其中161例行TACE+PMCT治疗(观察组),369例行纯TACE治疗(对照组),两组疗法均可重复操作,直至CT显示肿瘤消融完全。比较两组患者治疗后的总体生存率(OS)和无瘤生存率(RFS),并分析预后的影响因素。结果:因纳入的两组患者间基线存在差异,故采用倾向得分匹配(PSM)对两组患者行1:1配对,最终从两组患者中匹配出150对基线特征均衡的患者。300例患者的中位随访时间为24.5个月,观察组中位OS时间与中位RFS时间均明显长于对照组(43.1个月vs.19.0个月,P=0.001;36.0个月vs.16.7个月,P=0.002)。两组患者1、2年OS和RFS差异无统计学意义(均P>0.05),但观察组3、4、5年OS及RFS均明显优于对照组(均P<0.05)。Cox多因素回归分析显示,TACE+PMCT(HR=1.473,95%CI=1.094~1.983,P=0.011),肝硬化(HR=1.101,95%CI=1.041~1.165,P=0.001)是复发性HCC患者OS的独立影响因素;TACE+PMCT(HR=1.093,95%CI=1.037~1.151,P=0.001)和分化程度(HR=1.445,95%CI=1.135~1.840,P=0.003)是复发性HCC患者RFS的独立影响因素。结论:TACE联合PMCT是复发性HCC安全有效的治疗方式,其临床疗效优于单纯TACE治疗,可明显改善复发性HCC患者的预后。
Background and Aims:For recurrent hepatocellular carcinoma(HCC),liver transplantation and repeat hepatectomy are the major treatment methods,but they all have their limitations and are not applicable to all patients.Moreover,transarterial chemoembolization(TACE)and percutaneous microwave ablation(PMCT)are also effective methods for recurrent HCC.However,whether the combined treatment of TACE and PMCT can further improve the treatment efficacy has not been reported.Therefore,this study was aimed to compare the clinical efficacy of TACE plus PMCT and TACE alone in treatment of recurrent HCC.Methods:According to the inclusion criteria,the clinical data of 530 patients treated in the Department of Hepatobiliary Surgery of the Affiliated Hospital of Southwest Medical University from January 2007 to January 2019 were collected.Of the patients,161 cases underwent TACE plus PMCT treatment(observation group),and 369 cases underwent PMCT alone(control group).Patients in both groups underwent repeated performance of the procedures until complete tumor ablation shown by CT examination.The overall survival rate(OS)and relapse-free survival(RFS)of the two groups after treatment were compared,and the prognostic factors were also analyzed.Results:There were differences in some baseline data between the two groups of patients,so the two groups of patients were 1:1 matched by propensity score matching(PSM)method,and then resulted in 150 pairs of patients with balanced baseline data from the two groups.In the 300 patients,the median follow-up time was 24.5 months.the median OS and RFS in observation group were significantly longer than those in control group(43.1 months vs.19.0 months,P=0.001;36.0 months vs.16.7 months,P=0.002).The 1-and 2-year OS and RFS between the two groups showed no significant differences(all P>0.05),but the 3-,4-and 5-year OS and RFS in observation group were significantly superior to those in control group(all P<0.05).Cox multivariate regression analysis showed that TACE plus PMCT treatment(HR=1.473,95%CI=1
作者
舒强
刘小玲
杨小李
苏松
罗斌
李波
SHU Qiang;LIU Xiaoling;YANG Xiaoli;SU Song;LUO Bin;LI Bo(Department of Hepatobiliary Surgery,the First People's Hospital of Neijiang,Neijiang,Sichuan 641000,China;Department of Hepatobiliary Surgery,the Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,China;School of Public Health,Southwest Medical University,Luzhou,Sichuan 646000,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2020年第1期11-18,共8页
China Journal of General Surgery
关键词
癌
肝细胞
肿瘤复发
局部
化学栓塞
治疗性
消融技术
预后
Carcinoma
Hepatocellular
Neoplasm Recurrence
Local
Chemoembolization
Therapeutic
Ablation Techniques
Prognosis
