微波消融联合经肝动脉化疗栓塞术治疗原发性肝癌合并门静脉癌栓的效果及影响因素

周传力; 田世超; 陈晓理; 黄进; 张显平; 张雪妍; 徐亚吉

doi:10.3969/j.issn.1001-5256.2019.10.018

微波消融联合经肝动脉化疗栓塞术治疗原发性肝癌合并门静脉癌栓的效果及影响因素

DOI: 10.3969/j.issn.1001-5256.2019.10.018

1. 成都市第七人民医院普外科
2. 四川大学华西医院肝胆胰外科
3. 成都大学医学院基础医学部

基金项目:

四川省教育厅科研项目(17ZB0119)；

详细信息

中图分类号: R735.7
计量
- 文章访问数: 1395
- HTML全文浏览量: 55
- PDF下载量: 287
- 被引次数: 0
出版历程
- 收稿日期: 2019-06-05
- 出版日期: 2019-10-20

Clinical effect of microwave ablation combined with transcatheter arterial chemoembolization in treatment of primary hepatocellular carcinoma with portal vein tumor thrombus and related influencing factors

Department of General Surgery,Chengdu Seventh People's Hospital

Research funding:

摘要

摘要: 目的探讨微波消融（MWA）联合经肝动脉化疗栓塞术（TACE）治疗原发性肝癌（PHC）合并门静脉癌栓（PVTT）的效果及主要影响因素。方法选取2016年1月-2018年3月成都市第七人民医院收治的PHC合并PVTT患者92例,其中接受MWA联合TACE治疗的患者为联合组（n=47）,仅接受TACE治疗的为对照组（n=45）。观察2组患者治疗后短期疗效、生存情况、不良反应、并发症发生率,以及完全缓解（CR）、部分缓解（PR）、疾病稳定（SD）和疾病进展（PD）;比较2组患者术后3个月治疗有效率（RR）。计量资料2组间比较采用t检验,计数资料2组间比较采用χ2检验。用Kaplan-Meier法进行生存分析,log-rank检验对各项可能因素进行单因素分析,用Cox逐步回归方法进行多因素分析。结果治疗结束后3个月,联合组和对照组RR分别为42.2%和11. 9%,差异有统计学意义（χ2=8. 679,P <0. 05）。2组患者治疗后3 d均出现发热、恶心呕吐和肝区疼痛等不良反应。联合组患者1、2、3年累积生存率分别为44. 7%、23. 4%、6. 4%,对照组患者1、2、3年累积生存...
- 肝肿瘤 /
- 消融技术 /
- 经肝动脉化疗栓塞术 /
- 危险因素
Abstract: Objective To investigate the clinical effect of microwave ablation(MWA) combined with transcatheter arterial chemoembolization(TACE) in the treatment of primary hepatocellular carcinoma(PHC) with portal vein tumor thrombus(PVTT) and related influencing factors. Methods A total of 92 patients with PHC and PVTT who were admitted to Chengdu Seventh People's Hospital from January 2016 to March 2018 were enrolled,among whom 47 patients treated with MWA combined with TACE were enrolled as combined treatment group and 45 treated with TACE alone were enrolled as control group. The two groups were compared in terms of short-term outcome,survival,incidence rates of adverse reactions and complications,and rates of complete response(CR),partial response(PR),stable disease(SD),and progressive disease(PD),as well as response rate(RR) at 3 months after surgery(RR = CR + PR). The t-test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier method was used for survival analysis,the log-rank test was used for univariate analysis of possible factors,and a Cox stepwise regression analysis was used for multivariate analysis. Results At 3 months after the treatment ended,there was a significant difference in RR between the combined treatment group and the control group(42. 2% vs 11. 9%,χ2= 8. 679,P < 0. 05). The adverse reactions such as pyrexia,nausea and vomiting,and liver area pain were observed in both groups. The combined treatment group had 1-,2-,and 3-year cumulative survival rates of 44. 7%,23. 4%,and 6. 4%,respectively,and the control group had 1-,2-,and 3-year cumulative survival rates of 22. 5%,8. 9%,and 0,respectively. The combined treatment group had a significantly longer median survival time than thecontrol group(10. 9 months vs 5. 1 months,χ2= 5. 749,P < 0. 05). Preoperative alpha-fetoprotein,number of tumors,tumor size,type of PVTT,Barcelona Clinic Liver Cancer(BCLC) stage,and Child-Pugh class were associated with the survival of the patients with PHC and PVTT(χ2= 9. 356,7. 641,11. 352,9. 764,8. 236,and 17. 392,all P < 0. 05). The multivariate analysis showed that tumor size(hazard ratio[HR]= 1. 997,95% confidence interval [CI]: 1. 608-3. 145,P < 0. 05),type of PVTT(HR = 1. 584,95% CI: 1. 306-2. 757,P< 0. 05),BCLC stage(HR = 1. 690,95% CI: 1. 035-2. 683,P < 0. 05) were independent influencing factors for survival. Conclusion MWA combined with TACE has good safety and efficacy in the treatment of patients with PHC and PVTT. Tumor size,type of PVTT,BCLC stage are the main influencing factors for prognosis.
- liver neoplasms /
- ablation techniques /
- transcatheter arterial chemoembolization /
- risk factors

HTML全文

参考文献(28)

[1] CHEN W,ZHENG R,BAADE PD,et al. Cancer statistics in China,2015[J]. Ca Cancer J Clin,2016,66(2):115-132.

[2] TORRE LA,BRAY F,SIEGEL RL,et al. Global cancer statistics,2012[J]. Ca Cancer J Clin,2015,65(2):87-108.

[3] LIN DX,ZHANG QY,LI X,et al. An aggressive approach leads to improved survival in hepatocellular carcinoma patients with portal vein tumor thrombus[J]. J Cancer Res Clin,2011,137(1):139-149.

[4] ZHANG ZM,LAI EC,ZHANG C,et al. The strategies for treating primary hepatocellular carcinoma with portal vein tumor thrombus[J]. Int J Surg,2015,20:8-16.

[5] LI MG,ZHAO YL,LIU XL,et al. Effect of different minimally invasive therapies on the prognosis of patients with HBV-related primary liver cancer complicated by portal vein tumor thrombus[J]. J Clin Hepatol,2017,33(4):684-688.(in Chinese)李梦阁,赵亚林,刘晓利,等.不同微创治疗方法对HBV相关原发性肝癌合并门静脉癌栓患者的预后影响[J].临床肝胆病杂志,2017,33(4):684-688.

[6] CHAN S,CHONG C,CHAN A,et al. Management of hepatocellular carcinoma with portal vein tumor thrombosis:Review and update at 2016[J]. World J Gastroenterol,2016,22(32):7289-7300.

[7] LIU KC,LYU WF,ZHOU CZ,et al. Curative effect and influencing factors of hepatocellular carcinoma with portal vein tumor thrombosis treated with TACE[J]. Chin J Interv Imaging Ther,2018,15(6):331-336.(in Chinese)刘开才,吕维富,周春泽,等. TACE治疗原发性肝细胞癌合并门静脉癌栓疗效及影响因素[J].中国介入影像与治疗学,2018,15(6):331-336.

[8] ZHANG J,DONG BW,LIANG P,et al. Functional assessment of infiltrating immunocytes in patients with primary hepatocellular carcinoma after percutaneous microwave coagulation therapy[J]. Natl Med J China,2001,81(16):974-977.(in Chinese)张晶,董宝玮,梁萍,等.原发性肝癌经皮微波凝固治疗前后局部免疫活性细胞功能检测[J].中华医学杂志,2001,81(16):974-977.

[9] LI Z,MI DH,YANG KH,et al. Effectiveness and safety of TACE combined with MWA for primary hepatic cancer:A systematic review[J]. J Intervent Radiol,2015,24(11):957-963.(in Chinese)李征,米登海,杨克虎,等.经动脉化疗栓塞联合微波消融治疗肝癌有效性和安全性的系统评价[J].介入放射学杂志,2015,24(11):957-963.

[10] National Health and Family Planning Commission of the People’s Republic of China. Diagnosis,management,and treatment of hepatocellular carcinoma(V2017)[J]. J Clin Hepatol,2017,33(8):1419-1431.(in Chinese)中华人民共和国卫生和计划生育委员会.原发性肝癌诊疗规范(2017年版)[J].临床肝胆病杂志,2017,33(8):1419-1431.

[11] FORNER A,REIG ME,de LOPE CR,et al. Current strategy for staging and treatment:The BCLC update and future prospects[J]. Semin Liver Diss,2010,30(1):61-74.

[12] SHAYA FT,BREUNIG IM,MULLINS CD,et al. Comparative analysis of treatments,utilization,and survival benefit in HCC patients:A real-world analysis of SEER Medicare[J]. J Clin Oncol,2012,30(4 Suppl):214.

[13] CHENG SQ,SUN JX,SHI J. Bottleneck and strategies in the treatment of hepatocellular carcinoma with portal vein tumor thrombus[J]. Chin J Dig Surg,2018,17(5):426-429.(in Chinese)程树群,孙居仙,石洁.肝癌合并门静脉癌栓治疗的瓶颈与对策[J].中华消化外科杂志,2018,17(5):426-429.

[14] ABDELAZIZ AO,NABEEL MM,ELBAZ TM,et al. Microwave ablation versus transarterial chemoembolization in large hepatocellular carcinoma:Prospective analysis[J]. Scand J Gastroenterol,2015,50(4):1-6.

[15] ZHANG L,YIN X,GAN YH,et al. Radiofrequency ablation following first-line transarterial chemoembolization for patients with unresectable hepatocellular carcinoma beyond the Milan criteria[J]. BMC Gastroenterol,2014,14:11.

[16] WU L,YANG YF,SHEN SQ,et al. Percutaneous microwave ablation and radiofrequency ablation for the treatment of portal vein tumor thrombus:Clinical analysis of 80 cases[J]. J Intervent Radiol,2016,25(6):510-514.(in Chinese)伍路,杨业发,申淑群,等.门静脉癌栓微波消融及射频消融治疗80例分析[J].介入放射学杂志,2016,25(6):510-514.

[17] LIU C,LIANG P,LIU F,et al. MWA combined with TACE as a combined therapy for unresectable large-sized hepotocellular carcinoma[J]. Int J Hyperther,2011,27(7):654-662.

[18] LOFFROY R. Interventional radiology for hepatocellular carcinoma[J]. Minerva Gastroenterol Dietol,2011,57(3):299-309.

[19] XU LF,CHEN YT,REN Q,et al. Clinical application of transarterial chemoembolization combining with air-cooled percutaneous microwave coagulation therapy on patients with primary hepatic carcinoma[J]. Chin J Clin Oncol,2007,34(10):553-557.(in Chinese)许林锋,陈耀庭,任强,等. TACE联合冷循环PMCT治疗原发性肝癌的临床应用[J].中国肿瘤临床,2007,34(10):553-557.

[20] ZHAO D,LIANG B,WANG Y,et al. Tumor lysis syndrome after transcatheter arterial chemoembolization:Report of one case[J]. J Intervent Radiol,2018,27(5):461-463.(in Chinese)赵丹,梁斌,王勇,等.肝癌化疗栓塞后溶瘤综合征1例[J].介入放射学杂志,2018,27(5):461-463.

[21] NI JY,XU LF,CHEN YT,et al. Long-term results and prognostic affecting factors of combined interventional therapies for treatment of intermediate and advanced primary liver cancer[J]. J Sun Yat-Sen Univ:Medical Sciences,2013,34(5):734-738.(in Chinese)倪嘉延,许林锋,陈耀庭,等.联合介入治疗中晚期原发性肝癌远期疗效及影响因素分析[J].中山大学学报:医学科学版,2013,34(5):734-738.

[22] ZHAO P,ZHENG JS,ZHANG HH,et al. Efficacy evaluation and exploration of TACE combined with CT-guided precision microwave ablation treatment for primary liver cancer[J]. Chin J Oncol,2016,38(2):138-145.(in Chinese)赵鹏,郑加生,张洪海,等.肝动脉导管化疗栓塞联合CT引导精准微波消融治疗原发性肝癌的疗效及影响因素[J].中华肿瘤杂志,2016,38(2):138-145.

[23] ELTAWIL KM,BERRY R,ABDOLELL M,et al. Quality of life and survival analysis of patients undergoing transarterial chemoembolization for primary hepatic malignancies:A prospective cohort study[J]. HPB,2012,14(5):341-350.

[24] LIANG P,YU J,YU XL,et al. Percutaneous cooled-tip microwave ablation under ultrasound guidance for primary liver cancer:A multicentre analysis of 1363 treatment-naive lesions in 1007 patients in China[J]. Gut,2012,61(7):1100-1101.

[25] BRUIX J,SHERMAN M. Management of hepatocellular carcinoma:An update[J]. Hepatology,2011,53(3):1020-1022.

[26] HUANG SM,CHEN SK,ZHANG T. Analysis of the clinical effect and prognostic factors of postoperative TACE combined with hepatic carcinectomy in the treatment of primary carcinoma of the liver with portal vein tumor thrombus[J]. Chin J Front Med Sci,2016,8(6):160-164.(in Chinese)黄书明,陈圣开,张涛.肝癌切除术联合术后TACE对肝癌合并门静脉癌栓患者的治疗效果及预后影响因素分析[J].中国医学前沿杂志,2016,8(6):160-164.

[27] CHENG SQ,SUN JX,SHI J. Bottleneck and strategies in the treatment of hepatocellular carcinoma with portal vein tumor thrombus[J]. Chin J Dig Surg,2018,17(5):426-429.(in Chinese)程树群,孙居仙,石洁.肝癌合并门静脉癌栓治疗的瓶颈与对策[J].中华消化外科杂志,2018,17(5):426-429.

[28] NIU ZJ,MA YL,KANG P,et al. Transarterial chemoembolization compared with conservative treatment for advanced hepatocellular carcinoma with portal vein tumor thrombus:Using a new classification[J]. Med Oncol,2012,29(4):2992-2997.

施引文献

资源附件(0)

访问统计