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
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Key words
recurrent hepatocellular carcinoma /
transcatheter arterial chemoembolization /
microwave ablation /
propensity score match /
overall survival /
progression-free survival
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脚注
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基金
国家重点研发计划项目(2017YFC0110401)
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