TACE联合超声引导经皮微波消融治疗术后复发性肝细胞癌的临床研究

姜婷婷, 牟培源, 段伟宏, 刘全达, 白媛媛, 雷磊

暨南学报(哲学社会科学版) ›› 2022, Vol. 43 ›› Issue (3) : 284-292.

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暨南学报(哲学社会科学版) ›› 2022, Vol. 43 ›› Issue (3) : 284-292. DOI: 10.11778/j.jdxb.20210365
临床医学

TACE联合超声引导经皮微波消融治疗术后复发性肝细胞癌的临床研究

  • 姜婷婷1, 牟培源2,*, 段伟宏2, 刘全达2, 白媛媛2, 雷磊2
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Clinical research on combined TACE and ultrasound guided microwave ablation for recurrent hepatocellular carcinoma after initial surgery

  • JIANG Tingting1, MU Peiyuan2,*, DUAN Weihong2, LIU Quanda2, BAI Yuanyuan2, LEI Lei2
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摘要

目的: 比较肝动脉化疗栓塞(TACE)联合超声引导下经皮微波消融(TACE-MWA)与单独TACE在肝癌根治性切除后复发性肝癌(RHCC)中的疗效。方法: 回顾性研究2014年1月至2017年12月我院107例RHCC患者的临床资料,其中TACE组60例,TACE-MWA组47例。比较两组患者的总生存期、无进展生存期,并分析预后影响因素。为平衡两组间的协变量差异,使用1:1倾向性得分匹配(PSM)。结果: PSM前,TACE组和TACE-MWA组5年生存率分别为17.7%,35%(P=0.027);5年无进展生存率分别为13.4%,28.9%(P=0.029)。PSM后,TACE组和TACE-MWA组5年生存率分别为15.3%,39.5%(P=0.038);5年无进展生存率分别为12.6%, 31.2%(P=0.049)。在亚组分析中,肿瘤复发时间(TTR)≤1年,TACE组和TACE-MWA组5年生存率分别为12.8%,16.7%(P=0.959);TTR>1年,TACE组和TACE-MWA组5年生存率分别为21.3%, 46.6%(P=0.020)。经Cox回归分析后,肿瘤分化程度、初次肝切除后微血管侵犯(MVI)和复发肿瘤直径>3 cm是影响RHCC患者总生存期和无进展生存期的独立危险因素(P<0.05)。结论: 对于TTR>1年的RHCC患者,TACE-MWA疗效优于TACE。肿瘤分化程度低、MVI阳性、复发肿瘤直径>3 cm,影响RHCC患者远期疗效。

Abstract

Objective: To compare and evaluate the efficacy of transcatheter arterial chemoembolization combined with ultrasound guided percutaneous microwave ablation (TACE-MWA) and transcatheter arterial chemoembolization (TACE) alone in the treatment of recurrent hepatocellular carcinoma (RHCC) after radical resection of liver cancer. Methods: From January 2014 to December 2017,107 patients with RHCC who underwent TACE alone (n=60) or TACE-MWA (n=47) after initial surgery in our hospital, were studied retrospectively. Overall survival (OS) and progression-free survival (PFS) were compared and the prognostic factors were analyzed. To balance the covariate differences between the two groups, 1:1 Propensity score match (PSM) was performed. Results: Before PSM, the 5-year OS rates were 17.7% and 35%(P=0.027), and the 5-year PFS rates were 13.4% and 28.9%(P=0.029)for TACE alone and TACE-MWA groups, respectively. After PSM, the 5-year OS rates were 15.3% and 39.5% (P=0.038), and the 5-year PFS rates were 12.6% and 31.2% (P=0.049) for the groups of TACE alone and TACE-MWA, respectively. The analysis of subgroup results showed that the 5-year OS rates were 12.8% and 16.7% (P=0.959) for the groups of TACE and TACE-MWA when time to recurrence (TTR) ≤1 year; and 21.3% and 46.6% (P=0.020) when TTR>1 year. Cox regression analysis indicated that the degree of tumor differentiation, microvascular invasion (MVI) after primary hepatectomy and recurrent tumor diameter >3 cm were independent risk factor affecting OS and PFS (both P<0.05) of patients with RHCC. Conclusion: For patients with RHCC, the efficacy of TACE-MWA is superior to TACE alone when TTR >1 year. Moreover, poorly differentiated, MVI positive and tumor diameter >3 cm are not conducive to long-term curative effect.

关键词

复发性肝癌 / 肝动脉化疗栓塞 / 微波消融 / 倾向性匹配分析 / 总生存期 / 无进展生存期

Key words

recurrent hepatocellular carcinoma / transcatheter arterial chemoembolization / microwave ablation / propensity score match / overall survival / progression-free survival

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姜婷婷, 牟培源, 段伟宏, 刘全达, 白媛媛, 雷磊. TACE联合超声引导经皮微波消融治疗术后复发性肝细胞癌的临床研究. 暨南大学学报(自然科学与医学版). 2022, 43(3): 284-292 https://doi.org/10.11778/j.jdxb.20210365
JIANG Tingting, MU Peiyuan, DUAN Weihong, LIU Quanda, BAI Yuanyuan, LEI Lei. Clinical research on combined TACE and ultrasound guided microwave ablation for recurrent hepatocellular carcinoma after initial surgery. Journal of Jinan University Natural Science & Medicine Edition. 2022, 43(3): 284-292 https://doi.org/10.11778/j.jdxb.20210365

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基金

国家重点研发计划项目(2017YFC0110401)
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