经肝动脉化疗栓塞联合局部消融治疗外科术后复发性肝癌的预后分析

冀柏宇; 郝芬林; 海江涛; 张俊生; 吴向阳; 金栋; 卢震辉

doi:10.3969/j.issn.1001-5256.2022.07.021

经肝动脉化疗栓塞联合局部消融治疗外科术后复发性肝癌的预后分析

DOI: 10.3969/j.issn.1001-5256.2022.07.021

1.
宁夏医科大学研究生院，银川 750004
2.
昆明医科大学第三附属医院肝胆胰外科，昆明 650100
3.
宁夏医科大学总医院肝胆外科，银川 750003

基金项目:

宁夏自然科学基金 (2019AAC03192);

宁夏科技厅重点研发项目 (2020BEG03004);

宁夏回族自治区科技惠民专项项目 (2021CMG03014);

宁夏回族自治区科技惠民专项项目 (2021CMG03015);

宁夏回族自治区科技基础条件建设计划创新平台资金项目 (2020CXPT0007)

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：冀柏宇负责资料收集，数据分析及文章撰写；郝芬林、海江涛、张俊生、吴向阳负责课题设计，研究指导，审校并最终定稿；金栋、卢震辉负责指导文章撰写。

详细信息

通信作者:
卢震辉，zhenhuilu@hotmail.com

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出版历程
- 收稿日期: 2021-11-14
- 录用日期: 2021-12-20
- 出版日期: 2022-07-20

A prognostic analysis of transcatheter arterial chemoembolization combined with local ablation in treatment of recurrent liver cancer after surgery

1.
Graduate School of Ningxia Medical University, Yinchuan 750004, China
2.
Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming 650100, China
3.
Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, Yinchuan 750003, China

Research funding:

Natural Science Foundation of Ningxia Province (2019AAC03192);

Key R & D Project of Ningxia Science and Technology Department (2020BEG03004);

Special Project of Science and Technology benefiting the People of Ningxia Hui Autonomous Region (2021CMG03014);

Special Project of Science and Technology benefiting the People of Ningxia Hui Autonomous Region (2021CMG03015);

Ningxia Hui Autonomous Region Science and Technology Infrastructure Construction Plan Innovation Platform Fund (2020CXPT0007)

More Information

Corresponding author: LU Zhenhui, zhenhuilu@hotmail.com(ORCID: 0000-0003-3509-7837)

摘要

摘要: 目的探讨外科术后复发性肝癌经肝动脉化疗栓塞(TACE)联合局部消融治疗的临床疗效及影响预后的危险因素。方法回顾性分析2017年1月—2020年12月于宁夏医科大学总医院接受TACE联合局部消融治疗的47例外科术后复发性肝癌患者的资料。局部消融治疗后开始随访，评价近期疗效并随访其生存情况。对可能影响预后的因素作单因素及多因素分析，单因素分析运用Kaplan-Meier模型及log-rank检验分析，多因素分析采用Cox比例风险回归模型。结果 47例外科术后复发性肝癌患者治疗后3个月，总体有效率(ORR)为89.3%，疾病控制率(DCR)为95.7%；6、12、18、24个月总生存率分别为95.70%、76.40%、63.30%、58.00%。单因素分析及Cox比例风险回归显示：肿瘤边界不规整(RR=3.938，95%CI：1.709~9.073，P=0.005)和肿瘤位置临近危险区域(大血管、空腔脏器等)(RR=3.202，95%CI：1.415~7.245，P=0.001)与患者术后生存相关。结论 TACE联合局部消融是治疗外科术后复发性肝癌的一种较为有效的治疗方式。肿瘤边界不完整和肿瘤位置临近危险区域(大血管、空腔脏器等)是影响此类患者术后生存的危险因素。
- 肝肿瘤 /
- 化学栓塞, 治疗性 /
- 消融技术 /
- 预后
Abstract: Objective To investigate the clinical effect of transcatheter arterial chemoembolization (TACE) combined with local ablation in the treatment of recurrent liver cancer after surgery, as well as the risk factors for prognosis. Methods A retrospective analysis was performed for the data of 47 patients with recurrent liver cancer after surgery who received TACE combined with local ablation in General Hospital of Ningxia Medical University from January 2017 to December 2020. The patients were followed up after local ablation to assess short-term outcome and survival. Univariate and multivariate analyses were used to investigate the factors affecting prognosis; the Kaplan-Meier model and the log-rank test were used for univariate analysis, and the Cox proportional-hazards regression model was used for multivariate analysis. Results At 3 months after treatment, the 47 patients with recurrent liver cancer after surgery had an overall effective rate of 89.3% and a disease control rate of 95.7%, and the overall survival rates at 6, 12, 18, and 24 months were 95.70%, 76.40%, 63.30%, and 58.00%, respectively. The univariate analysis and the Cox proportional-hazards regression analysis showed that irregularity of tumor boundary (risk ratio [RR]=3.938, 95% confidence interval [CI]: 1.709-9.073, P=0.005) and proximity of tumor to risk areas (major blood vessels and hollow visceral organs, etc.) (RR=3.202, 95% CI: 1.415-7.245, P=0.001) were associated with postoperative survival. Conclusion TACE combined with local ablation is an effective treatment modality for recurrent liver cancer after surgery, and irregularity of tumor boundary and proximity of tumor to risk areas (major blood vessels and hollow visceral organs, etc.) are the risk factors affecting the postoperative survival of such patients.
- Liver Neoplasms /
- Chemoembolization, Therapeutic /
- Ablation Techniques /
- Prognosis

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图 1 47例复发性肝癌患者治疗后生存曲线

Figure 1. Survival curve of 47 patients with recurrent liver cancer after treatment

下载: 全尺寸图片幻灯片

表 1 影响患者OS的单因素分析

Table 1. Univariate analysis of affecting patient OS

因素	例数	中位OS(月)	χ²值	P值
性别			0.754	0.385
男	33	22
女	14	25
年龄			0.003	0.953
≥60岁	23	23
＜60岁	24	24
PLT			0.066	0.798
≥100×10⁹/L	32	23
＜100×10⁹/L	15	22
ALT			0.294	0.588
≥40 U/L	11	24
＜40 U/L	36	22
AST			0.459	0.498
≥45 U/L	30	24
＜45 U/L	17	22
Child-Pugh分级			0.479	0.489
A级	29	25
B级	18	22
AFP			3.861	0.049
≥40 ng/mL	20	16
＜40 ng/mL	27	25
肿瘤直径			3.933	0.047
≥3 cm	19	16
＜3 cm	28	25
肿瘤数目			0.508	0.476
单个	32	23
2~3个	15	34
肿瘤边界			5.531	0.021
规整	28	25
不规整	19	18
肿瘤位置是否临近危险区域(大血管、空腔脏器等)			7.920	0.005
是	11	18
否	36	34

下载: 导出CSV

表 2 影响患者OS的多因素分析

Table 2. Multivariate analysis of affecting patient OS

因素	RR	B值	SE	Wald	95%CI	P值
肿瘤边界(规整/不规整)	3.938	1.164	0.417	7.804	1.709~9.073	0.005
肿瘤位置是否临近危险区域(是/否)	3.202	1.371	0.426	10.361	1.415~7.245	0.001

下载: 导出CSV

参考文献(19)

[1]	GRUTTADAURIA S, BARBERA F, CONALDI PG, et al. Clinical and molecular-based approach in the evaluation of hepatocellular carcinoma recurrence after radical liver resection[J]. Cancers (Basel), 2021, 13(3): 518. DOI: 10.3390/cancers13030518.
[2]	SONG Q, REN W, FAN L, et al. Long-term outcomes of transarterial chemoembolization combined with radiofrequency ablation versus transarterial chemoembolization alone for recurrent hepatocellular carcinoma after surgical resection[J]. Dig Dis Sci, 2020, 65(4): 1266-1275. DOI: 10.1007/s10620-019-05733-0.
[3]	PENG ZW, ZHANG YJ, LIANG HH, et al. Recurrent hepatocellular carcinoma treated with sequential transcatheter arterial chemoembolization and RF ablation versus RF ablation alone: A prospective randomized trial[J]. Radiology, 2012, 262(2): 689-700. DOI: 10.1148/radiol.11110637.
[4]	DI COSTANZO GG, TORTORA R, D'ADAMO G, et al. Radiofrequency ablation versus laser ablation for the treatment of small hepatocellular carcinoma in cirrhosis: a randomized trial[J]. J Gastroenterol Hepatol, 2015, 30(3): 559-565. DOI: 10.1111/jgh.12791.
[5]	YOON SM, RYOO BY, LEE SJ, et al. Efficacy and safety of transarterial chemoembolization plus external beam radiotherapy vs sorafenib in hepatocellular carcinoma with macroscopic vascular invasion: A randomized clinical trial[J]. JAMA Oncol, 2018, 4(5): 661-669. DOI: 10.1001/jamaoncol.2017.5847.
[6]	TAO Q, HE W, LI B, et al. Resection versus resection with preoperative transcatheter arterial chemoembolization for resectable hepatocellular carcinoma recurrence[J]. J Cancer, 2018, 9(16): 2778-2785. DOI: 10.7150/jca.25033.
[7]	ZHENG J, CAI J, TAO L, et al. Comparison on the efficacy and prognosis of different strategies for intrahepatic recurrent hepatocellular carcinoma: A systematic review and Bayesian network meta-analysis[J]. Int J Surg, 2020, 83: 196-204. DOI: 10.1016/j.ijsu.2020.09.031.
[8]	WANG C, LIAO Y, QIU J, et al. Transcatheter arterial chemoembolization alone or combined with ablation for recurrent intermediate-stage hepatocellular carcinoma: A propensity score matching study[J]. J Cancer Res Clin Oncol, 2020, 146(10): 2669-2680. DOI: 10.1007/s00432-020-03254-2.
[9]	LYU TS, ZOU YH, WANG J, et al. Current status of transcatheter arterial chemoembolization combined with radiofrequency ablation in treatment of primary liver cancer[J]. J Clin Hepatol, 2016, 32(1): 49-55. DOI: 10.3969/j.issn.1001-5256.2016.01.007. 吕天石, 邹英华, 王健, 等. 经肝动脉化疗栓塞术联合射频消融治疗原发性肝癌的现状[J]. 临床肝胆病杂志, 2016, 32(1): 49-55. DOI: 10.3969/j.issn.1001-5256.2016.01.007.
[10]	WANG T, WANG CY, LIU JY, et al. Effectiveness and safety of ultrasound-guided ablation in treatment of primary liver cancer in dangerous areas[J]. J Clin Hepatol, 2021, 37(7): 1594-1598. DOI: 10.3969/j.issn.1001-5256.2021.07.023. 王婷, 王春妍, 刘建勇, 等. 超声引导下局部消融治疗危险区域原发性肝癌的效果及安全性分析[J]. 临床肝胆病杂志, 2021, 37(7): 1594-1598. DOI: 10.3969/j.issn.1001-5256.2021.07.023.
[11]	LIU YY, LAI JX. Minimally invasive interventional therapy for liver cancer[J/CD]. Chin J Hepat Surg (Electronic Edition), 2020, 9(3): 201-205. DOI: 10.3877/cma.j.issn.2095-3232.2020.03.001. 刘允怡, 赖俊雄. 肝癌微创介入治疗[J/CD]. 中华肝脏外科手术学电子杂志, 2020, 9(3): 201-205. DOI: 10.3877/cma.j.issn.2095-3232.2020.03.001.
[12]	SHI YP, ZHAI B. Local treatment of liver cancer: Ablation or resection?[J]. J Clin Hepatol, 2021, 37(3): 506-509. DOI: 10.3969/j.issn.1001-5256.2021.03.003. 史瑶平, 翟博. 肝癌局部治疗——消融或切除?[J]. 临床肝胆病杂志, 2021, 37(3): 506-509. DOI: 10.3969/j.issn.1001-5256.2021.03.003.
[13]	RUAN JQ, CHEN X, ZHANG HH, et al. Clinical effect of radio frequency ablation combined with trans catheter arterial chemoembolization in the treatment of primary liver cancer with portal vein tumor thrombus[J]. China Med Herald, 2020, 17(20): 25-28, 33. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY202020008.htm 阮健秋, 陈欣, 张红环, 等. 射频消融术联合肝动脉化疗栓塞治疗原发性肝癌伴门静脉癌栓的临床效果[J]. 中国医药导报, 2020, 17(20): 25-28, 33. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY202020008.htm
[14]	GAO LL, QIN SX, CHEN W, et al. Efficacy of TACE combined with RFA in the treatment of mid-term primary liver cancer and its influence on serum levels of GP73, AFP and AFP-L3[J]. J Clin Exp Med, 2021, 20(13): 1388-1391. DOI: 10.3969/j.issn.1671-4695.2021.13.012. 高磊磊, 秦帅鑫, 陈威, 等. TACE联合RFA治疗中期原发性肝癌的疗效及对患者血清GP73、AFP和AFP-L3水平的影响[J]. 临床和实验医学杂志, 2021, 20(13): 1388-1391. DOI: 10.3969/j.issn.1671-4695.2021.13.012.
[15]	PENG Z, WEI M, CHEN S, et al. Combined transcatheter arterial chemoembolization and radiofrequency ablation versus hepatectomy for recurrent hepatocellular carcinoma after initial surgery: A propensity score matching study[J]. Eur Radiol, 2018, 28(8): 3522-3531. DOI: 10.1007/s00330-017-5166-4.
[16]	ZHANG H, XU XB, HE XJ, et al. Comparison of the efficacy of combination of transcatheter arterial chemoembolization and radio frequency ablation and re-operation on postoperative recurrent primary carcinoma of liver[J]. J Xinxiang Med Coll, 2014, 31(11): 928-930. DOI: 10.7683/xxyxyxb.2014.11.018. 张辉, 徐新保, 何晓军, 等. 肝动脉栓塞化学治疗联合射频消融与再次手术切除治疗原发性肝癌术后复发的疗效比较[J]. 新乡医学院学报, 2014, 31(11): 928-930. DOI: 10.7683/xxyxyxb.2014.11.018.
[17]	WANG TT. A new prognostic model of early tumor progression after local thermal ablation of hepatocellular carcinoma[D]. Tianjin: Tianjin Medical University, 2019. 王婷婷. 肝癌局部热消融后肿瘤早期进展的预测模型[D]. 天津: 天津医科大学, 2019.
[18]	ZONG YY, XU H, XU W, et al. Sequential therapy of TACE followed by percutaneous microwave coagulation for early-stage primary hepatocellular carcinomas: Curative effect and prognostic factors[J]. J Intervent Radiol, 2015, 24(3): 210-214. DOI: 10.3969/j.issn.1008-794X.2015.03.007. 宗迎迎, 徐浩, 许伟, 等. 经肝动脉化疗栓塞联合经皮微波消融序贯治疗早期肝癌的疗效及预后影响因素[J]. 介入放射学杂志, 2015, 24(3): 210-214. DOI: 10.3969/j.issn.1008-794X.2015.03.007.
[19]	FU Y, JI JS, TU JF, et al. The clinical application of TACE combined with RFA and sorafenib in treating recurrent hepatocellular carcinoma after surgery[J]. J Intervent Radiol, 2015, 24(12): 1067-1071. DOI: 10.3969/j.issn.1008-794X.2015.12.010. 付元, 纪建松, 涂建飞, 等. TACE联合RFA及索拉菲尼在肝癌外科术后复发治疗中的临床应用[J]. 介入放射学杂志, 2015, 24(12): 1067-1071. DOI: 10.3969/j.issn.1008-794X.2015.12.010.