经导管肝动脉化疗栓塞（TACE）联合经皮射频消融术（RFA）治疗中晚期肝癌的疗效及预后影响因素分析

摘要

Objective To evaluate the efficacy of transcatheter arterial chemoembolization( TACE) combined with radio-frequency ablation( RFA) for middle and advanced hepatocellular carcinoma and prognostic factors.Methods 128 patients with middle and advanced hepatocellular carcinoma were divided into 2 groups,each with 64 patients.TACE group were given TACE one or several times,TACE+RFA group were given RFA 1~2 weeks after TACE.Results In TACE group and TACE+RFA group,the total effective rates were 68.75%(44/64) and 95.31% (61/64),the median survival time were 13 months and 18 months.The 1-and 2-year survival rates in the TACE+RFA group were 73.4%(47/64) and 20.3%(13/64) .The 1-and 2-year survival rates in the TACE group were 56.25%(36/64) and 7.81%(5/64).Tumor number,staging,diameter and level of AFP were related with prognosis.Conclusion TACE combined with RFA can significantly increase survival rate and prolong survival period of patients,tumor number,staging,diameter and level of AFP are risk factors affecting prognosis.%目的：探讨经导管肝动脉化疗栓塞（TACE）联合经皮射频消融术（RFA）治疗中晚期肝癌的临床疗效及安全性并分析影响预后因素。方法将中晚期原发性肝癌患者128例分为肝动脉化疗栓塞组（ TACE组）与肝动脉化疗栓塞联合经皮射频消融术（ RFA）组（ TACE＋RFA组），各64例。 TACE组患者行一次或多次单一肝动脉化疗治疗；TACE＋RFA组在肝动脉化疗治疗结束后1～2周再行经皮射频消融术治疗。结果 TACE组与TACE＋RFA组总有效率分别为68．75％（44／64）、95．31％（61／64）；中位生存时间分别为13与18个月；TACE＋RFA组1年生存率为73．4％（47／64），2年生存率为20．3％（13／64），而TACE组分别为56．25％（36／64）和7．81％（5／64）；预后影响因素分析结果显示肿瘤数量、分期、直径、血清甲胎蛋白水平等与患者预后有相关性。结论经导管肝动脉化疗栓塞（ TACE）联合经皮射频消融术（ RFA）治疗原发性中晚期肝癌可以有效提高患者生存率，延长患者的生存期，其肿瘤数量、分期、直径等4项指标是影响患者预后的危险因素。