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经肝动脉化疗栓塞术联合射频消融治疗巴塞罗那B期原发性肝癌的效果及预后影响因素分析
Clinical effect of transcatheter arterial chemoembolization combined with radiofrequency ablation in treatment of Barcelona Clinical Liver Cancer stage B primary liver cancer and influencing factors for prognosis
文章发布日期:2019年03月07日  来源:  作者:孙玉,张洪海,生守鹏,等  点击次数:162次  下载次数:29次

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【摘要】:目的探讨经肝动脉化疗栓塞术(TACE)联合肝癌射频消融(RFA)治疗巴塞罗那(BCLC)B期原发性肝癌患者的疗效及其预后影响因素。方法选择2007年1月-2012年1月在首都医科大学附属北京佑安医院住院行TACE联合RFA治疗的BCLC-B期原发性肝癌患者154例。收集所有患者基线实验室及影像检查资料,通过门诊、住院或电话随访所有病例。采用Kaplan-Meier法绘制生存曲线,采用log-rank检验生存曲线,将单因素分析中P<0.05的指标纳入多因素Cox回归分析。结果154例BCLC-B期肝癌患者,中位生存期37个月,1、2、3、5年生存率分别为82.5%、59.7%、50.6%和36.1%。将患者按照BCLC-B期亚分期分为B1、B2、B3、B4期,B1期患者生存率明显高于B2~B4期,差异有统计学意义(χ2=16.881,P=0.001);RFA后1个月达到完全消融、年龄<60岁、术前AFP<400 ng/ml、胆碱酯酶≥4000 U/L、TBil≤21μmol/L、Child-Pugh A级,肿瘤数目≤3个、肿瘤最大直径<3 cm组患者生存率分别高于不完全消融、年龄≥60岁、AFP≥400 ng/ml、胆碱酯酶<4000 U/L、TBil>21 μmol/L、Child-Pugh B级、肿瘤数目>3个、肿瘤最大直径>5 cm组,差异均有统计学意义(χ2=173.002, P<0.001; χ2=6.336, P=0.012; χ2=10.765, P=0001; χ2=6.933, P=0.008; χ2=4.624, P=0.032; χ2=5.570, P=0.018; χ2=6.761, P=0.009; χ2=7.430, P=0.024)。Cox多因素回归分析显示消融评价[P<0.001,比值比(OR)=21.950, 95%可信区间(95%CI):11.817~40.772]、Child-Pugh分级(P=0.002,OR=2.190, 95%CI:1.329~3.609)、AFP水平(P=0.014,OR=1.760, 95%CI:1.122~2.760)、B期亚分期(P=0.004,OR=2.178, 95%CI:1.284~3.694)是BCLC-B期肝癌患者RFA治疗后生存期的影响因素。结论TACE联合RFA治疗BCLC-B期肝癌安全有效,不完全消融、AFP≥400 ng/ml、Child-Pugh B级、BCLC-B期亚分期越晚是影响BCLC-B期肝癌RFA治疗后生存期的独立危险因素。
【Abstract】:ObjectiveTo investigate the clinical effect of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in the treatment of Barcelona Clinical Liver Cancer (BCLC) stage B primary liver cancer and influencing factors for prognosis. MethodsA total of 154 patients with BCLC stage B primary liver cancer who were admitted to Beijing YouAn Hospital, Capital Medical University, from January 2007 to January 2012 and underwent TACE combined with RFA were enrolled. Baseline laboratory data and imaging findings were collected for all patients, and all patients were followed up by the outpatient service, hospitalization, or telephone. The Kaplan-Meier method was used to plot survival curves and the log-rank test was used for the analysis of survival curves. The indicators with P<0.05 in the univariate analysis were included in multivariate Cox regression analysis. ResultsThe 154 patients with BCLC stage B liver cancer had a median survival time of 37 months and the 1-, 2-, 3-, and 5-year survival rates were 82.5%, 59.7%, 50.6%, and 36.1%, respectively. The patients were divided into B1, B2, B3, and B4 groups according to the BCLC substage, and the B1 group had a significantly higher survival rate than the B2, B3, and B4 groups (χ2=16.881, P=0.001). The patients with complete ablation at one month after RFA, an age of <60 years, an alpha-fetoprotein (AFP) level of <400 ng/ml, a cholinesterase (ChE) level of ≥4000 U/L, a total bilirubin (TBil) level of ≤21 μmol/L, a Child-Pugh class A disease, a number of tumors of ≤3, or a maximum tumor diameter of <3 cm had a significantly higher survival rate than those with incomplete ablation (χ2=173.002, P<0.001), an age of ≥60 years (χ2=6.336, P=0.012), an AFP level of ≥400 ng/ml (χ2=10.765, P=0.001), a ChE level of <4000 U/L (χ2=6.933, P=0008), a TBil level of >21 μmol/L (χ2=4.624, P=0.032), a Child-Pugh class B disease (χ2=5.570, P=0.018), a number of tumors of >3 (χ2=6.761, P=0.009), or a maximum tumor diameter of >5 cm (χ2=7.430, P=0.024). The multivariate Cox regression analysis showed that ablation assessment (odds ratio [OR]=21.950, 95% confidence interval [CI]: 11.817-40.772, P<0.001), Child-Pugh class (OR=2.190, 95%CI:1.329-3.609, P=0.002), AFP level (OR=1.760, 95%CI: 1.122-2.760, P=0014), and BCLC B substage (OR=2.178, 95%CI: 1.284-3.694, P=0.004) were influencing factors for survival time after RFA in patients with BCLC stage B liver cancer. ConclusionTACE combined with RFA is safe and effective in the treatment of BCLC stage B liver cancer. Incomplete ablation, a AFP level of ≥400 ng/ml, Child-Pugh class B, and late substage of BCLC stage B are independent risk factors for survival time after RFA in patients with BCLC stage B liver cancer.
【关键字】:肝肿瘤; 化学栓塞, 治疗性; 导管消融术; 治疗结果; 预后; 危险因素
【Key words】:liver neoplasms; chemoembolization, therapeutic; catheter ablation; treatment outcome; prognosis; risk factors
【引证本文】:SUN Y, ZHANG HH, SHENG SP, et al. Clinical effect of transcatheter arterial chemoembolization combined with radiofrequency ablation in treatment of Barcelona Clinical Liver Cancer stage B primary liver cancer and influencing factors for prognosis[J]. J Clin Hepatol, 2019, 35(4): 818-824. (in Chinese)
孙玉, 张洪海, 生守鹏, 等. 经肝动脉化疗栓塞术联合射频消融治疗巴塞罗那B期原发性肝癌的效果及预后影响因素分析[J]. 临床肝胆病杂志, 2019, 35(4): 818-824.

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