不同时间间隔的肝动脉化疗栓塞和射频消融联合治疗中晚期肝癌的预后分析

应希慧; 赖林强; 陈丽; 杨宏远; 纪建松; 涂建飞

doi:10.16766/j.cnki.issn.1674-4152.002496

不同时间间隔的肝动脉化疗栓塞和射频消融联合治疗中晚期肝癌的预后分析

doi: 10.16766/j.cnki.issn.1674-4152.002496

浙江省影像诊断与介入微创研究重点实验室，浙江大学丽水医院介入诊疗中心，浙江丽水 323000

基金项目:

浙江省医药卫生重大科技计划重点项目 WKJ-ZJ-1932

浙江省基础公益研究计划项目 LGF18H220001

浙江省医药卫生科技计划项目面上项目 2018KY933

浙江省医药卫生科技计划项目 2020ZH087

详细信息

通讯作者:
涂建飞, E-mail: jianfei1133@163.com

中图分类号: R735.7R730.58
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出版历程
- 收稿日期: 2021-07-02
- 网络出版日期: 2022-09-21

Prognostic analysis of hepatic arterial chemoembolization and radiofrequency ablation combination with different time intervals for patients with advanced hepatocellular carcinoma

Key Laboratory of Imaging Diagnosis and Minimally Invasive and Intervention Research of Zhejiang Province, Department of Radiology Lishui Hospital of Zhejiang University, Lishui, Zhejiang 323000, China

摘要

摘要: 目的探讨不同时间间隔肝动脉化疗栓塞术(TACE)联合射频消融(RFA)序贯治疗中晚期肝癌(HCC)的效果。方法回顾浙江大学丽水医院介入诊疗中心2012年2月—2017年12月99例HCC患者的临床资料，所有患者均接受了TACE和RFA序贯治疗。根据TACE和RFA的治疗间隔时间，将患者分为3组，分别为A组(0~5 d，30例)、B组(6~22 d，54例)和C组(＞22 d，15例)。使用递归分割法选择最合适的TACE-RFA间期阈值，主要研究终点为总生存期(OS)，次要研究终点为肿瘤无进展生存期(PFS)与治疗相关的不良事件。结果末次随访时间为2020年12月30日。分析结果显示较长的TACE-RFA时间间隔与较差的OS相关：A组vs. B组，P=0.694；A组vs. C组，P=0.037；B组vs. C组，P=0.023。C组15例患者中，73.3%(11/15)的患者死亡。3组中位OS分别为32.3、34.1和23.2个月。结论 TACE和RFA序贯时间间隔与患者预后有关，较短的时间间隔可以提高中晚期HCC患者的OS和PFS，但最佳的时间间隔仍需进一步大样本多中心临床研究确认。
- 肝细胞癌 /
- 化疗栓塞术 /
- 射频消融术 /
- 生存 /
- 疗效
Abstract: Objective To investigate the appropriate interval between transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) in treatment of advanced hepatocellular carcinoma (HCC). Methods The clinical data of 99 patients with HCC in Department of Radiology Lishui Hospital of Zhejiang University was retrospectively collected from February 2012 to December 2017. All patients received sequential treatment of TACE and RFA. The treatment interval of TACE and RFA was calculated, and the patients were divided into 3 subgroups: group A (0-5 days, n=30), group B (6-22 days, n=54), and Group C (>22 days, n=15). Recursive segmentation was used to select the most appropriate TACE-RFA interval threshold. The primary study endpoint was overall survival (OS), and the secondary study endpoint was tumor progression-free survival (PFS) and treatment-related adverse events. Results The last follow-up time was December 30, 2020. The data showed that longer TACE-RFA time intervals were associated with poor OS (group A vs. group B, P=0.694; group A vs. Group C, P=0.037; group B vs. group C, P=0.023). Among the 15 patients in group C, 73.3% (11/15) died. The median OS of the 3 subgroups were 32.3, 34.1, and 23.2 months, respectively. Conclusion The time interval between TACE and RFA is related to the prognosis of HCC patients. The shorter time intervals can improve OS and PFS in HCC patients. However, the optimal time interval still needs to be confirmed by large-scale multi-center clinical trials.
- Hepatocellular carcinoma /
- Chemoembolization /
- Radiofrequency ablation /
- Survival /
- Efficacy

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图 1 3组中晚期HCC患者OS比较

Figure 1. Comparison of OS in three groups of patients with advanced HCC

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图 2 3组中晚期HCC患者PFS比较

Figure 2. Comparison of PFS in three groups of patients with advanced HCC

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图 3 去除转移相关因素后3组中晚期HCC患者OS比较

Figure 3. Comparison of OS in three groups of patients with advanced HCC after removal of metastasis related factors

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图 4 去除转移相关因素后3组中晚期HCC患者PFS比较

Figure 4. Comparison of PFS in three groups of patients with advanced HCC after removal of metastasis related factors

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表 1 3组中晚期HCC患者一般资料比较

Table 1. Comparison of general data of three groups in patients with advanced HCC

项目	A组(n=30)	B组(n=54)	C组(n=15)	统计量	P值
年龄(x±s, 岁)	57.7±12.5	55.9±10.5	57.2±10.4	0.275^a	0.764
性别[例(%)]				1.800^b	0.430
女性	2(6.7)	6(11.1)	3(20.0)
男性	28(93.3)	48(88.9)	12(80.0)
HBV(HBsAg)[例(%)]				0.463^b	0.407
阴性	1(3.3)	6(11.1)	1(6.7)
阳性	29(96.7)	48(88.9)	14(93.3)
肝硬化[例(%)]	27(90.0)	36(66.7)	12(80.0)	5.891^b	0.053
KPS评分(x±s, 分)	91.7±4.6	89.6±6.7	88.0±6.8	2.048^a	0.143
肿瘤最大径(x±s, cm)	4.3±3.0	5.0±3.3	5.2±2.0	0.646^a	0.567
肿瘤数目[例(%)]				0.717^b	0.699
单发	14(46.7)	28(51.9)	6(40.0)
多发性	16(53.3)	26(48.1)	9(60.0)
远处转移[例(%)]				2.550^b	0.279
无	26(86.7)	41(75.9)	10(66.7)
有	4(13.3)	13(24.1)	5(33.3)
Child-Pugh分级[例(%)]				0.256^b	0.870
A	27(90.0)	48(88.9)	14(93.3)
B	3(10.0)	6(11.1)	1(6.7)
注：^a为F值，^b为χ²值。

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表 2 3组中晚期HCC患者OS影响因素的Cox回归分析

Table 2. Cox regression analysis of overall survival and prognosis of three groups in patients with advanced HCC

项目	B	SE	Wald χ²	P值	HR(95% CI)
年龄	-0.341	0.212	1.231	0.762	1.012(0.652~1.346)
性别	0.433	0.181	1.872	0.673	0.983(0.762~1.454)
病灶大小	0.568	0.118	2.430	0.080	1.219(0.889~2.718)
转移	0.272	0.032	8.228	0.028	1.538(1.262~2.214)
WBC	0.215	0.121	1.212	0.539	1.112(0.778~1.977)
TBA	0.318	0.204	1.080	0.777	0.882(0.652~1.761)
TACE-RFA时间间隔	0.408	0.178	1.981	0.211	0.789(0.628~1.651)

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