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目的探讨肝动脉化疗栓塞(transarterial chemoembolization,TACE)联合射频消融(radiofrequency ablation,RFA)对于直径>5 cm的肝细胞肝癌(hepatocellular carcinoma,HCC)的治疗效果。方法回顾性分析2007年1月~2014年1月30例直径>5 cm的HCC患者资料,年龄34~83岁,(58.4±12.7)岁。肝内肿瘤均为单发,直径5~17 cm,(7.0±2.6)cm。肝功能Child-Pugh评分A级19例,B级11例。患者一般状态卡氏功能状态(Karnofsky performance status,KPS)评分70~100分,(88.6±10.3)分。治疗顺序:先行TACE治疗,TACE后适时给予RFA。随访过程中如发现肿瘤局部残存或复发,仍行TACE结合RFA治疗。随访终点事件为患者死亡或随访期结束(2014年1月)。采用Kaplan-Meier法进行生存期分析,并对随访结束时尚存活患者的Child-Pugh评分和KPS评分进行治疗前后的统计学比较。结果经TACE和RFA联合治疗后,30例初始病灶中完全灭活23例(76.7%),未完全灭活7例(23.3%)。随访期内24例(80%)出现肝内新发病灶,6例(20%)未再出现新发病灶。至随访终止,完全缓解(complete remission,CR)9例(30%),部分缓解(partial remission,PR)1例(3.3%),疾病进展(progression of disease,PD)7例(23.3%),死亡13例(43.3%)。存活患者随访期内Child-Pugh评分及KPS评分变化无统计学意义(P>0.05)。全组随访时间13~60个月,(34.1±14.1)月。中位生存期48个月(95%CI 34~62个月)。1、3、5年生存率分别为96.7%、69.5%、33.2%。结论本研究进一步证实TACE联合RFA安全有效,可以控制HCC患者肝内病变的进展,改善其生活质量,生存期数据满意。对于直径>5 cm的HCC患者,TACE联合RFA是有效的治疗手段之一。
Objective To investigate the therapeutic effect of transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) on hepatocellular carcinoma (HCC)> 5 cm in diameter. Methods Thirty patients with HCC> 5 cm in diameter from January 2007 to January 2014 were retrospectively analyzed. Their ages ranged from 34 to 83 years (58.4 ± 12.7 years). Intrahepatic tumors were single, diameter 5 ~ 17 cm, (7.0 ± 2.6) cm. Liver function Child-Pugh score A grade 19 cases, B grade 11 cases. The patient’s Karnofsky performance status (KPS) score was 70-100 (88.6 ± 10.3). Treatment sequence: first TACE treatment, timely delivery of RFA after TACE. Follow-up process if found in the tumor remains or relapse, TACE is still in line with RFA treatment. The end of follow-up event was the patient’s death or the end of the follow-up period (January 2014). Survival analysis was performed using Kaplan-Meier method and the Child-Pugh and KPS scores of surviving patients survived at the end of follow-up were compared before and after treatment. Results After TACE and RFA combined treatment, 23 cases (76.7%) were completely inactivated in 30 cases and 7 cases (23.3%) were not completely inactivated. In the follow-up period, 24 cases (80%) showed new intrahepatic lesions, and 6 cases (20%) showed no new lesions. Nine patients (30%) had complete remission (CR), one patient (3.3%) had partial remission (PR), seven patients (23.3%) had progression of disease (PD) Thirteen patients died (43.3%). There was no significant difference in Child-Pugh score and KPS score between survivors and follow-up (P> 0.05). The whole group was followed up for 13 to 60 months (34.1 ± 14.1) months. The median survival was 48 months (95% CI, 34 to 62 months). The 1, 3, 5 year survival rates were 96.7%, 69.5% and 33.2% respectively. Conclusions This study further confirmed that TACE combined with RFA was safe and effective, which could control the progress of intrahepatic lesions in HCC patients and improve their quality of life. The data of survival were satisfactory. TACE in combination with RFA is an effective treatment for HCC patients> 5 cm in diameter.